Comparing GreenLight PVP and HoLEP beyond 5 years: A systematic review of long‐term functional outcomes and reoperation rates

Abstract Objectives This study aimed to compare long‐term (≥ 5 years) functional outcomes and reoperation rates following holmium laser enucleation of prostate (HoLEP) vs GreenLight photoselective vaporisation of prostate (GLPVP). Methods MEDLINE, Embase and Cochrane databases were searched from inception to December 2023. Included were randomised controlled trials (RCTs), cohort studies and case series studying HoLEP and/or GLPVP, where functional outcomes and reoperation rates were reported. Studies with <5‐year follow‐up were excluded. Evidence was synthesised as a comparison across all parameters. Quality of evidence was assessed with the Newcastle–Ottawa Scale. Results Of 3047 records identified, 25 were eligible, including two RCTs, two cohort studies, one cross‐sectional study and 20 case series. Twenty‐three studies focused on HoLEP or GLPVP, whilst two were comparative studies. HoLEP demonstrated long‐term durability of outcomes and low reoperation rates (mean 4.1%, range 2.0%–6.3%) at a mean follow‐up of 7.3 years. GLPVP also had durable outcomes at 5‐year follow‐up, but inconclusive evidence for improvements at 10 years. Reoperation rates were also higher (mean 12.6%, range 3.8%–33.3%). This is in keeping with findings of comparative studies, where HoLEP demonstrated greater improvements in all functional parameters except PVR, and lower reoperation rates. Findings are limited by patient attrition, lack of comparative studies and long‐term data beyond 10 years. Three studies examined the 180‐W GLPVP model at 5 years showed superior durability to earlier 80‐W/120‐W models. Conclusions Current evidence suggests that HoLEP provides significantly greater functional improvements and a lower reoperation rate when compared with the GLPVP 80‐W/120‐W model at 5‐year follow‐up. The 180‐W model is comparable with HoLEP based on limited data at 5 years, but there is a lack of data beyond 10 years for longer‐term functional outcomes.