Randomized trial of bipolar resection vs. Holmium laser enucleation vs. Greenlight laser vapo-enucleation of the prostate for treatment of large sized benign prostate obstruction; 3-years outcome.

PURPOSE To assess the non-inferiority of transurethral resection in saline (TURis) and Greenlight laser Vapo-Enucleation of the prostate (GL.PVEP) to Holmium laser enucleation of the prostate (HoLEP) for controlling lower urinary tract symptoms secondary to large sized BPH with comparable 3-years-retreatment rate. METHODS Eligible patients with BPH (80-150ml) were randomly assigned to one of the intervention groups. Non-inferiority of retreatment rate was evaluated using a 1-sided test at 5% level of significance. RESULTS At time of analysis, 60 GL.PVEP, 60 HoLEP and 62 TURis procedures were included. Perioperative parameters were comparable between groups however; longer operative time (92+32, 73+30 and 83+28min, P=0.005) and less operative efficiency (1.2+0.4, 1.7+0.7 and 1.4+0.6gm/min, P=0.000) have been reported in GL.PVEP vs. HoLEP and TURis respectively. Perioperative complications and need for auxiliary procedures were similar in the three groups however significantly higher rate of capsular violation 5, 8% was reported in TURis group compared to 1, 1.6% in GL.PVEP and none in HoLEP, p=0.01. Significantly longer hospital-stay, catheter-time and higher rate of blood transfusion were reported following TURis. There was significant comparable improvement in IPSS in 3 groups at different follow-up points. At 3 years, retreatment for recurrent BOO was more after GL.PVEP and TURis. More redo surgeries for recurrent obstructing prostate adenoma was reported after GL.PVEP (4, 6.7%) and TURis (6, 9.7%) in comparison to HoLEP (none) (P=0.04). CONCLUSION The perioperative outcome of GL.PVEP and HoLEP surpasses that of TURIS for treatment of large sized prostate with significantly more operative time with GL.PVEP. The three techniques achieve good functional outcome however 3-years retreatment rate following TURIS and GL.PVEP was inferior to HoLEP.