Prostate Volume Reduction: TURP vs GreenLight Laser

Comparative Efficacy in Volume Reduction

TURP provides greater prostate volume reduction (44%) compared to GreenLight laser photoselective vaporization of the prostate (PVP) (31%) at 3 months post-procedure, according to the European Association of Urology 1
TURP remains the gold standard surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) for prostates between 30-80 ml in size, with superior tissue removal capabilities, as recommended by the European Urology Association 2, 3
GreenLight laser PVP demonstrates comparable efficacy to TURP in terms of symptom improvement at 36 months follow-up, despite removing less prostate tissue, according to the European Urology Association 2, 4

When comparing PVP with Holmium Laser Enucleation of the Prostate (HoLEP) in patients with prostate volume >60 ml, HoLEP provided significantly higher flow rates and lower post-void residual, suggesting superior tissue removal, as reported by the European Urology Association 4

GreenLight laser can be safely performed in high-risk patients and those receiving anticoagulation therapy due to its excellent hemostatic properties, according to the European Urology Association 4, 5

When using PVP for larger prostates (>60 ml), there is a 22% conversion rate to TURP, which should be considered when planning procedures for patients with larger prostates, as noted by the European Urology Association 4, 5
The reoperation rate after 180-W XPS GreenLight laser was comparable with TURP, but significantly higher after 120-W HPS laser (11% vs 1.8%; p=0.04), according to the European Urology Association 4

For patients prioritizing faster recovery and reduced bleeding risk, GreenLight PVP may be preferable despite less volume reduction, as suggested by the European Urology Association 5
For patients with larger prostates (>80 ml) requiring maximum tissue removal, TURP or enucleation procedures like HoLEP may be more appropriate, according to the European Urology Association 2, 6

The choice between procedures should consider prostate size, patient comorbidities (especially bleeding risk), and surgeon experience, as recommended by the European Urology Association 2, 4