Comparison of Urodynamic Outcomes of Surgery Using the Photoselective Vaporization <scp>180 W XPS</scp> System and Transurethral Resection of the Prostate: A Propensity Score‐Matched Analysis in Real‐World Clinical Practice

ABSTRACT Objectives No previous studies have directly compared pre‐ and postoperative pressure flow study (PFS) outcomes between transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate using the GreenLight XPS laser system (PVP‐XPS). After an institutional transition from TURP to PVP‐XPS in November 2020, we retrospectively compared PFS outcomes in a single‐center real‐world setting. Methods We included the last 50 consecutive TURP cases and the first 50 PVP‐XPS cases performed during the transition period. Baseline characteristics were compared, and propensity score matching (PSM) was applied to adjust for differences in age and prostate volume. The primary endpoint was postoperative bladder outlet obstruction index (BOOI) at 6 months. Results The mean age was 73.7 years in the PVP group and 71.9 years in the TURP group ( p = 0.18). The prostate volume was significantly larger in the PVP group (74.7 mL) than in the TURP group (53.2 mL, p &lt; 0.01). After PSM, postoperative BOOI did not differ significantly between the PVP group (10.6 ± 18.8) and the TURP group (13.0 ± 17.3). The proportion of patients with Schafer obstruction grade 3–6 was 6% in the PVP group and 3% in the TURP group. The mean change in BOOI was −42.0 ± 29.3 in the TURP group and −47.8 ± 34.6 in the PVP group, with no significant difference ( p = 0.46). Conclusions With the institutional transition from TURP to PVP‐XPS, patients with larger prostate volumes were treated. After PSM, postoperative BOOI and the magnitude of BOOI improvement were comparable between the two procedures.