Greenlight Vaporization vs Xpeeda Vaporesection
Greenlight Vaporization vs Xpeeda Vaporesection
Bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia
 (BPH) is a common problem, which impact patients' quality of life. It may lead to serious
 outcomes, including urinary tract infection, hematuria, bladder stones, urinary retention,
 hydronephrosis, and rarely renal insufficiency.

 Introduction of the Holmium laser enucleation of the prostate (HoLEP) represented a turning
 point in minimally invasive laser therapy for BPH as it achieves size-independent prostatic
 cavities similar to simple open prostatectomy with significantly lower perioperative
 morbidity.

 Recently, Holmium Xpeeda side firing fibre was introduced and it stands apart from other
 available technologies as a combination of power and efficiency, which minimizes vaporization
 time. This technology seems to revolutionize utilization of the Holmium power and delivering
 more energy directly to the tissue, due to its capability of being in contact with the
 tissue.

 To date, no outcomes of the new Xpeeda laser fiber have been reported in the literature,
 which is striving for trials comparing XPS 180W with other competitors such as Holmium
 vaporesection with the new fiber Xpeeda. Therefore, this study is planned to compare both
 procedures in improving bothersome LUTS secondary to BPH, and to evaluate safety and cost
 effectiveness.
Bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia
 (BPH) is a common problem, which impact patients' quality of life. It may lead to serious
 outcomes, including urinary tract infection, hematuria, bladder stones, urinary retention,
 hydronephrosis, and rarely renal insufficiency. Symptoms of BPH are due to prostatic
 enlargement, increased smooth muscle tone from the bladder and prostate, and changes in
 bladder contractility leading to lower urinary tract obstruction, which may cause permanent
 kidney damage if left untreated.

 Introduction of the Holmium laser enucleation of the prostate (HoLEP) represented a turning
 point in minimally invasive laser therapy for BPH as it achieves size-independent prostatic
 cavities similar to simple open prostatectomy with significantly lower perioperative
 morbidity. It has successfully passed the steps of validation through a growing number of
 well-designed randomized controlled studies to have a high level of evidence for safety and
 efficacy. The pulsed nature of holmium laser allows the plane of enucleation to be easier to
 develop and follow and gives superior visibility than the electro-cauterization with less
 charring of tissue.

 HoLEP proved itself as the only endoscopic procedure with superior efficacy compared to the
 traditional transurethral resection of the prostate (TURP). Furthermore, it is not only safe,
 effective, size-independent and durable even in patients with coagulopathy, but also more
 cost-effective than TURP. Meta-analyses have confirmed how well established HoLEP has now
 become, with a low long-term retreatment rate and the more pronounced improvement in prostate
 symptoms score and flow rate than after TURP.

 Recently, Holmium Xpeeda side firing fibre was introduced and it stands apart from other
 available technologies as a combination of power and efficiency, which minimizes vaporization
 time. This technology seems to revolutionize utilization of the Holmium power and delivering
 more energy directly to the tissue, due to its capability of being in contact with the
 tissue. Moreover, hemostasis would be improved by the pulse reshaping technology with a wider
 pulse width, activated by a dedicated footswitch. Therefore, the Lumenis Pulse™ 100W will
 make prostate vaporesection procedures more precise, faster and efficient, with excellent
 hemostasis. Consequently, bleeding is minimal, tissue is easier to remove and patients can
 have their catheter removed faster.

 On the other hand, Greenlight 532nm laser photoselective vaporization of the prostate (PVP)
 is an appealing treatment modality with hemoglobin as tissue target chromophore and
 relatively short learning curve. The introduction of the Xcelerated Performance System (XPS)
 180W in 2010 with the MoXy fibres represents the highest-powered system currently in use for
 this type of laser. It encourages the adoption of the enucleation principle, making it a real
 contender to HoLEP in treating large adenomas. Despite the fact that large prostates often
 require more energy and longer operative time, the XPS system has reduced the operative time
 and number of fibres required in these situations.

 Elmansy et al reported that Greenlight vaporization and Holmium laser ablation of the
 prostate (HoLAP) are effective surgical treatments for BPH in small to medium prostates. The
 two techniques have similar functional outcomes and complication rates. Subjective and
 objective voiding parameters showed significant improvement lasting for up to 3 years,
 confirming the long lasting, durable effects of each technique.

 To date, no outcomes of the new Xpeeda laser fiber have been reported in the literature,
 which is striving for trials comparing XPS 180W with other competitors such as Holmium
 vaporesection with the new fiber Xpeeda. Therefore, this study is planned to compare both
 procedures in improving bothersome LUTS secondary to BPH, and to evaluate safety and cost
 effectiveness.
Inclusion Criteria:

 1. Males over 50 years of age at the time of enrollment

 2. Referred to urology for refractory LUTS secondary to BPH

 3. Prostate size on preoperative TRUS of 40-80 ml

 4. IPSS >15, QOL score ≥3 and Qmax <15 ml/sec

 5. Written informed consent to participate in the study

 6. Ability to comply with the requirements of the study procedures

 Exclusion Criteria:

 1. Previous surgical treatment for BPH

 2. Presence of bladder stones

 3. History of prostate cancer

 4. Prostate size > 80 mL or <40 mL

 5. History of urethral stenosis or its management

 6. Known or suspected neurogenic bladder

 7. Participants with active urinary tract infection until appropriately treated

 8. Participants with preexisting conditions, which, in the opinion of the investigator,
 interfere with the conduct of the study.

 9. Participants who are uncooperative or cannot follow instructions.

 10. Participants who lack the capacity to provide free and informed written consent.