Efficacy of a vaporization-resection of the prostate median lobe enlargement and vaporization of the prostate lateral lobe for benign prostatic hyperplasia using a 120-W GreenLight high-performance system laser: the effect on storage symptoms.

GreenLight laser photoselective vaporization of the prostate (PVP) was established as a minimally invasive procedure to treat patients with benign prostatic hyperplasia (BPH). However, it may be difficult to achieve adequate tissue removal from a large prostate, particularly those with an enlarged median lobe. The purpose of this study was to investigate the feasibility and clinical effect of a 120-W GreenLight high-performance system laser vaporization-resection for an enlarged prostate median lobe compared with those of only vaporization. A total of 126 patients from January 2010 to January 2014 had an enlarged prostate median lobe and were included in this study. Ninety-six patients underwent vaporization only (VP group), and 30 patients underwent vaporization-resection for an enlarged median lobe (VR group). The clinical outcomes were International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum flow rate (Q max), and post-void residual urine volume (PVR) assessed at 1, 3, 6, and 12 months postoperatively between the two groups. The parameters were not significantly different preoperatively between the two groups, except for PVR. Operative time and laser time were shorter in the VR group than those in the VP group. (74.1 vs. 61.9 min and 46.7 vs. 37.8 min; P = 0.020 and 0.013, respectively) and used less energy (218.2 vs. 171.8 kJ, P = 0.025). Improved IPSS values, increased Q max, and a reduced PVR were seen in the two groups. In particular, improved storage IPSS values were higher at 1 and 3 months in the VR group than those in the VP group (P = 0.030 and 0.022, respectively). No significant complications were detected in either group. Median lobe tissue vaporization-resection was complete, and good voiding results were achieved. Although changes in urinary symptoms were similar between patients who received the two techniques, shorter operating time and lower energy were superior with the vaporization-resection technique. In addition, vaporization-resection may have a beneficial effect on storage symptoms.