HoLEP vs. Greenlight 532nm-laser PVEP vs. Bipolar TURP in Management of Moderate/ Large BPH
HoLEP vs. Greenlight 532nm-laser PVEP vs. Bipolar TURP in Management of Moderate/ Large BPH
Most guidelines are not strict for recommending single treatment approach for Moderate to
 large prostate.

 In this study the investigators planned to test the Greenlight (532-nm) laser Photoselective
 Vapo-Enucleation of the Prostate (PVEP) using (XPS) 180W system compared to bipolar
 transurethral resection of the prostate (TURis) and Holmium Laser Enucleation of the Prostate
 (HOLEP) in reduction of lower urinary tract symptoms (LUTS) secondary to BPH in a prospective
 randomized trial.
With a growing body of knowledge on the promising advancements and recent clinical data of
 the third generations of the Greenlight XPS, it seems to be a real contender in the world of
 MIS. Contenders of Greenlight laser technology includes bipolar as well as Holmium laser
 technology.

 In this study the investigators planned to test the Greenlight (532-nm) laser Photoselective
 Vapo-Enucleation of the Prostate (PVEP) using (XPS) 180W system compared to bipolar
 transurethral resection of the prostate (TURis) and Holmium Laser Enucleation of the Prostate
 (HOLEP) in reduction of LUTS secondary to BPH in a prospective randomized trial.

 Furthermore, all peri-operative parameters, urinary flow parameters, prostate size changes
 and complications associated with the procedures were compared. The prostate size limitations
 will be assessed in relation to the outcome measures.

 Moderate to large size prostate (80-120 ml TRUS estimated volume) will be randomized to PVEP
 vs. Bipolar TURP vs. HoLEP.
Inclusion Criteria:

 1. Patients' age ≥50 years

 2. LUTS secondary to BOO due to BPH who failed medical treatment

 3. International prostate symptom scores 8 (IPSS) >15 and bother score 8 (QOL) ≥ 3
 (according to IPSS question 8)

 4. Peak urinary flow rate (Qmax) <15 ml/sec with at least 125 ml voided volume or
 Patients with acute urine retention secondary to BPH who failed trial of voiding on
 medical treatment.

 5. ASA (American society of anaesthesiologists) score ≤3.

 6. TRUS prostate size (>/=80ml)

 Exclusion Criteria:

 1. Patient with neurological disorder which might affect bladder function as
 cerebrovascular stroke, Parkinson disease

 2. Active urinary tract infection,

 3. Presence of active bladder cancer (within the last 2 years)

 4. Known prostate cancer patients will be excluded preoperatively on the basis of digital
 rectal examination, prostate specific antigen level, and TRUS imaging followed by
 prostate biopsies if necessary.