Comparative efficacy and safety of greenlight laser vaporization, anatomical vaporization, and enucleation for benign prostatic hyperplasia: a systematic review and meta-analysis.

Abstract

This study compares the surgical and functional outcomes of photoselective vaporization of the prostate (PVP), anatomical PVP (aPVP), and Greenlight laser enucleation of the prostate (GreenLEP) in the treatment of benign prostatic hyperplasia (BPH). A comprehensive search was conducted in February 2024 across PubMed, the Cochrane Library, and EMBASE databases, following PRISMA guidelines and registered with PROSPERO (CRD42024518321). Thirteen studies were included, with 11 analyzed in the meta-analysis. Compared to PVP, aPVP had longer operation times (MD: -11.42 min, 95% CI: -15.70 to -7.14, p < 0.00001), higher energy utilization (MD: -56.83 kJ, 95% CI: -61.16 to -52.50, p < 0.00001), and greater energy density (MD: -0.57 kJ/mL, 95% CI: -0.75 to -0.39, p < 0.00001). GreenLEP showed superior energy efficiency (MD: 212.95 kJ, 95% CI: 40.41 to 385.50, p = 0.02) and functional outcomes, particularly in Qmax, PVR, and PSA levels at final follow-up. GreenLEP also had the lowest re-operation rate (OR: 27.30, 95% CI: 8.52 to 87.51, p < 0.00001) and was most effective for larger prostates. No significant differences in early, late, or major complications were observed across techniques. This meta-analysis highlights that aPVP and GreenLEP offer superior functional and efficiency benefits compared to PVP while maintaining comparable safety. GreenLEP is particularly advantageous for larger prostates, providing an effective and safe alternative.