When TURP meets PVP(XPS): Superior flow and resection efficiency in large-volume BPH (>80 g)

초록

Introduction & Objectives: Transurethral resection of the prostate (TURP) is limited by bleeding and prolonged resection in glands >80 g, while photoselective vaporization (PVP, Greenlight XPS 180 W) provides hemostasis but may leave residual tissue. We evaluated whether combined TURP+PVP(XPS) offers superior peri-operative and functional outcomes compared with either technique alone. Materials & Methods: We retrospectively analyzed consecutive BPH surgeries (2015–2025, Korea University Guro Hospital) with prostate volume >80 g, categorized as TURP (n = 29), XPS (n = 18), or combined (TURP+PVP(XPS), n = 114). Peri-operative variables (operation time, blood loss, hospital stay) and functional endpoints (ΔQmax, ΔPVR, ΔIPSS) were compared using Kruskal-Wallis and Welch's t-tests with pairwise contrasts. A p < 0.05 was considered significant. Results: Mean prostate volumes were 116.7 g (TURP), 95.0 g (XPS), and 110.9 g (combo). Operation time and Hb drop differed across groups (p < 0.05), and hospital stay was shortest with XPS (p < 0.001). Compared with TURP, the combo showed higher ΔQmax (+7.37 mL/s, 95% CI 3.11–11.64, p < 0.01) and greater ΔPVR improvement (+51.66 mL, 4.95–98.38, p < 0.05). Combo also surpassed XPS in ΔPVR (+42.19 mL, 5.48–78.90, p < 0.05), while ΔQmax difference vs XPS was nonsignificant (+5.09 mL/s, p = 0.072). No pairwise differences were observed in ΔIPSS. XPS and TURP did not significantly differ for any functional parameter. Conclusions: Combined TURP+PVP(XPS) achieved superior flow (ΔQmax) versus TURP and better residual urine reduction (ΔPVR) versus both monotherapies, without added morbidity. These findings highlight the complementary benefits of resection plus vaporization in very large prostates and support its further validation in prospective studies.