Best surgical treatment for very large benign prostatic obstruction

Table 1 Overview of the published studies

Ref.	Follow up (mo)	Patients (n)	Change in PSA		Change in symptoms (IPSS)		Change in Q max		Amount of tissue removed		Time urethral catheter (h)	Length of stay (h)
			ng/dL	%	Absolute	%	mL/seg	%	mL	%
Transvesical
Alivizatos et al[9], 2008	12	60	-4.3	-68.2	-13	-62	7.1	88.7	86	89.5	120	144
Ou et al[10], 2013	12	49	-4.4	-78.5	-19.3	-76.8	11.8	231.3	109.8	77.8	182	223
Rao et al[11], 2013	12	40	-3.91	-86.5	-21	-85.7	19.7	333.8	75.2	68.3	148	223
HoLEP
Elzayat et al[12], 2006	24	225	-8.1	-90	-14.3	-79.4	20	250	86	68.2	30	29
Matlaga et al[13], 2006	12	86	-8.86	-90.2	-14.5	-73.9	15.8	173.6	140	82.3	15.1	26
Kuntz et al[14], 2008	60	42			-19.2	-86.4	20.5	539.4
PVP with KTP
Rajbabu et al[15], 2007	24	54	-4.6	-41.8	-16.3	-74	11	137	59	43.7	23	11
Alivizatos et al[9], 2008	12	65	-3.8	-61.2	-11	-55	7.4	86	38	40.8	24	48
Bipolar TURP
Zhu et al[16], 2009	36	132	-4.17	-57.3	-18.5	-86.4	15.7	237.8	58.1	72.9	69	117
Enucleacion bipolar
Rao et al[11], 2013	12	43	-4.22	-88.4	-21.4	-86.2	20.8	358.6	65.9	56.8	79.2	129
Ou et al[10], 2013	12	45	-4.3	-72.8	-17.6	-75.8	9.6	162.7	98.7	74.7	103	139

PSA: Prostatic specific antigen; IPSS: International prostate symptoms score; HoLEP: Holmium laser enucleation of the prostate; TURP: Transurethral resection of the prostate; KTP: Potassium titanyl phosphate; PVP: Photo vaporization of the prostate.

Table 2 Complication rates of each technique

	Reoperation (%)	Urethral stenosis (%)	Transfusion (%)
Technique
Transvesical	5.3	7.9	9.8 (6.1-13.3)
HoLEP	1.33	0.66	0.84 (0-7.14)
PVP (KTP)	2.52 (0-3)	1.68 (0-2)	0
Bipolar TURP	4.5	4.5	0
Bipolar enucleation	2.5 (0-2.2)	2.4 (2.2-2.5)	7.5 (0-6.6)

HoLEP: Holmium laser enucleation of prostate; PVP: Photo-selective vaporization of prostate; KTP: Potassium titanyl phosphate; TURP: Transurethral resection of prostate.