Transurethral blue laser vaporization offers faster recovery and superior sexual function preservation in benign prostatic hyperplasia compared to hemi-holmium laser enucleation of the prostate: early results of a prospective randomized trial
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Benign prostatic hyperplasia (BPH) remains a significant quality-of-life concern for aging men, with surgical intervention often required for refractory symptoms. While holmium laser enucleation of the prostate (HoLEP) has emerged as a standard laser-based treatment, its impact on sexual function and procedural efficiency warrants exploration of alternatives [1]. Here we present a comparative evaluation of transurethral blue laser vaporization (TBLV), a novel 450 nm laser technique, against HoLEP in the treatment of BPH (Supplementary Figure S1). This prospective study enrolled 80 consecutive BPH patients between October 2023 and October 2024 at our institution. Participants were randomized to receive either TBLV (n = 32) or HoLEP (n = 48). The study focused on sexually active men aged 50-65 years with prostate volumes <100 mL, excluding those with pre-existing sexual dysfunction or significant comorbidities (see Supplementary Material for complete inclusion/exclusion criteria). The TBLV group underwent vaporization using a domestically developed 450 nm semiconductor laser system (Bluepolar Medical, China) operating at 150-200 W, while the HoLEP group received standard 100 W holmium laser treatment (Accu-Tech, USA). All HoLEP procedures in this study were performed as a Hemi-HoLEP technique, with the primary goal of preserving the bladder neck. This involved meticulous dissection to avoid any energy application to the sphincteric fibers proximal to the verumontanum. The objective was to create a wide channel while ensuring the circular muscle fibers of the bladder neck remained fully intact and clearly visible upon completion of the procedure. All procedures were performed by experienced surgeons under spinal-epidural or general anesthesia. The primary outcomes focused on sexual function preservation, assessed through nocturnal penile tumescence (NPT) testing, International Index of Erectile Function (IIEF) scores, and incidence of retrograde ejaculation at 3-month follow-up. No significant differences were observed in baseline sexual function indicators between the two groups preoperatively (all P > .05), indicating comparability in sexual function (Supplementary Table S1). Secondary outcomes included operative parameters (procedure time, catheter duration, hospital stay, enucleated tissue weight) (Supplementary Table S2), and urodynamic improvements (PVR, Qmax, IPSS) (Supplementary Table S4), with safety evaluated through complication rates (Supplementary Table S5). The TBLV group could not provide enucleated tissue weight due to the vaporization technique. Furthermore, the operative time for both groups was defined as the laser emission time recorded by the laser device. Our results demonstrated several notable advantages for TBLV. The procedure time was significantly shorter with TBLV (25.7 ± 5.3 min) compared to HoLEP (68.9 ± 5.7 minutes, P < .001), reflecting the higher vaporization efficiency of the 450 nm wavelength. Postoperative recovery metrics similarly favored TBLV, with catheter indwelling duration reduced by 2.5 days (1.2 ± 0.3 vs. 3.8 ± 1.4 days, P < .001) and hospital stay shortened by nearly 2 days (3.2 ± 0.5 vs. 5.2 ± 1.0 days, P < .001). These findings demonstrate that TBLV offers significant short-term advantages in the perioperative period, including shorter procedure time, faster catheter removal, and reduced hospital stay. Most importantly, TBLV showed superior outcomes in sexual function preservation [2]. At 3-month follow-up, TBLV patients exhibited better NPT results (87.5% normal function vs. 75.0% in HoLEP, P = .032) and significantly higher IIEF scores (17.4 ± 1.9 vs. 14.3 ± 1.3, P = .002). The incidence of retrograde ejaculation, a common concern after BPH surgery, was markedly lower in the TBLV group (3.1% vs. 10.4%, P = .008). These differences likely reflect the anatomical precision of the vaporization technique, which better preserves the bladder neck and surrounding tissues compared to the enucleation approach of HoLEP (Supplementary Table S3). Urodynamic improvements were comparable between groups, with both showing significant reductions in PVR (TBLV: 10.3 ± 3.2 mL; HoLEP: 11.6 ± 5.3 mL) and increases in Qmax (TBLV: 19.5 ± 5.5 mL/s; HoLEP: 20.9 ± 4.3 mL/s). However, TBLV demonstrated superior symptom relief as measured by IPSS (4.96 ± 1.27 vs. 6.62 ± 1.31, P = .028), suggesting potential advantages in quality-of-life outcomes. Safety profiles were similar between groups, with no severe complications reported in either arm (Supplementary Table S4 and S5). The technical advantages of the 450 nm blue laser likely contribute to these clinical outcomes [3]. With its strong absorption by hemoglobin and limited tissue penetration (0.5 ± 0.2 mm), this wavelength enables precise vaporization while minimizing thermal damage to surrounding structures. Previous preclinical work has demonstrated its rapid vaporization rate and thin coagulation layer, characteristics that may explain the faster recovery times observed in our study. The addition of a 50 W and 980 nm diode laser for hemostasis further enhances procedural efficiency. These findings build upon existing literature comparing laser modalities for BPH treatment. While HoLEP has shown advantages over traditional TURP in terms of hemostasis and recovery, concerns remain about its impact on sexual function. Our results suggest TBLV may address these limitations while maintaining comparable urodynamic efficacy. The sexual function outcomes are particularly relevant given the increasing emphasis on preserving quality-of-life in BPH management. Study limitations include the single-center design and relatively short follow-up period. The sample size, while adequate for detecting the primary outcomes, may be insufficient to identify rare complications. Additionally, the inability to obtain pathological specimens with TBLV requires careful patient selection to avoid missing occult malignancies. It is a key limitation of this study that the 3-month follow-up period does not allow for any assessment of long-term durability or re-operation rates. Therefore, comparisons regarding overall healthcare resource utilization cannot be made. Future multicenter studies with longer follow-up are needed to validate these findings and assess durability of outcomes. In conclusion, TBLV with 450 nm blue laser demonstrates several advantages over HoLEP [4], including shorter procedure times, faster recovery, and better preservation of sexual function. These benefits, combined with comparable urodynamic improvements and safety, position TBLV as an attractive option for BPH treatment, particularly for sexually active patients. The results warrant further investigation in larger, multicenter trials to establish long-term efficacy and broaden clinical adoption. We thank the participants and clinical staff for their contributions to this study. Statistical analysis support was provided by the Department of Biostatistics, Peking University Third Hospital. X.L.: Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review& editing. K.T. Conceptualization, Resources, Project administration. X.L.: Resources, Software. B.L.: Supervision, Validation; J.J.: Visualization. All authors read and approved the final manuscript. None declared. The authors declare no competing financial or non-financial interests. Deidentified data are available from the corresponding author upon reasonable request. Ethics approval was obtained from the Beijing Haidian Hospital Medical Ethics Committee. Informed consent was obtained from all individual participants included in the study.
Source: The Journal of Sexual Medicine
Authors: Xiaodong Lu, Kewei Tang, Xin Li, Baoguo Li, Jiawei Ji
Institutions: Peking University Third Hospital, Beijing Haidian Hospital
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,550
OpenAlex ID: W4416624978