Authors' objectives:

The objective of the report was to assess the available evidence on the safety and efficacy of PVP or Green laser for the treatment of BPH.

Authors' results and conclusions: No randomized controlled trials assessing PVP were found. Bachman et al. published a non-randomized controlled prospective trial comparing 64 patients who underwent PVP versus 37 who underwent TUR, with a six-month follow-up period. PVP was as effective as TUR as regards maximum urinary flow and prostate symptoms [according to the International Prostate Symptom Scale (IPSS)]. The urinary catheter was removed earlier in the PVP-treated group than in the rest, besides; it presented a shorter hospital stay (5.5 +/-2.7 days vs. 7.1 +/-1.8 days). Surgical time was somewhat shorter in patients undergoing TUR (49.4 +/- 16 minutes vs. 59.6 +/-24.4 minutes), but these patients required greater irrigation volumes and presented a higher hemoglobin and plasma sodium decrease, although there were not many clinical manifestations. Case series Eight case series were found including a total of 646 BPH patients treated with PVP. In all the series, IPSS improvement (between 50 and 84%), maximum flow increase between 10 and 20 ml/sec, operative times similar to those reported by Bachman and few complications were observed. Main complications were highly mild dysuria and hematuria, which did not require treatment, retrograde ejaculation and, in few cases, the need of a urinary catheter for more than a day. No cases of significant bleeding, clot retention, need for irrigation or impotency were reported. Patients on Anticoagulation Therapy Two studies specifically including patients on anticoagulation therapy were found. One case series report with 24 patients and one cohort study with 116 men on anticoagulation therapy and 92 with no anticoagulation undergoing PVP. No differences were observed in efficacy or safety parameters between both groups; there were no significant bleeding complications, nor need for transfusions.

Authors' recommendations: PVP has proved to be as effective as TUR for the treatment of BPH with fewer adverse effects, shorter time of urinary catheter use and early discharge. It is a procedure generally accepted by the health systems from different countries. It should be highlighted that the evidence comes from only one non-randomized controlled trial and case series, therefore more and better quality studies, with longer follow-up periods are required to confirm these findings.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)