GreenLight photoselective laser vaporisation versus transurethral resection of the prostate for large prostates: systematic review and meta-analysis.

Transurethral resection of the prostate (TURP) stands as a primary surgical intervention for benign prostatic hyperplasia (BPH), although laser techniques, notably photoselective vaporisation of the prostate (PVP), are gaining traction. Previous studies have already assessed the efficacy of TURP and PVP, although with small prostates (<70 mL). Thus, this systematic review and meta-analysis aims to assess the efficacy of PVP compared to TURP in the male BPH population with large prostates (≥70 mL). A systematic review was conducted across MEDLINE, Embase, Scopus, Web of Science, and Google Scholar. Studies comparing PVP to TURP in male BPH patients were included. Our primary outcome was the International Prostate Symptom Score (IPSS). Secondary outcomes encompassed maximum urinary flow rate (Qmáx), postvoid residual volume (Vres), operative time, catheterization time, postoperative hospital stay and complications. To assess the risk of bias we used Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomized studies, and risk of bias 2 tool (Cochrane) (RoB2) for the randomized. Three articles encompassing 159 patients each in the PVP and TURP groups were included. Our analysis revealed no statistically significant difference in IPSS score between PVP and TURP [mean difference (MD) 1.56; 95% confidence interval (CI): 0.52 to 3.64; P=0.14; I2=85%]. TURP demonstrated a reduced operative time (MD 30.35; 95% CI: 11.26 to 49.44; P=0.002; I2=96%), whereas PVP exhibited shorter catheterization time (MD -2.22; 95% CI: -2.44 to -1.99; P<0.001; I2=1%) and postoperative hospital stay (MD -2.20; 95% CI: -2.69 to -1.72; P<0.001; I2=75%). No significant differences were observed in other outcomes assessed. This meta-analysis suggests that PVP is non-inferior to TURP concerning IPSS, Qmáx, Vres, and complications, albeit with a longer operative time. PVP showed a reduced catheterization and postoperative hospital stay.