madman
Super Moderator
Abstract
Introduction
Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers.
Methods
Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications.
Results
At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64–77), 64 (47–90), 3.1 ng/mL (1.8–6), and 22 (19–27), respectively. Median lasing and operative time were 34 (23–48) and 62 min (46–85), respectively. Median energy use was 250.0 kJ (168.4–367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, the catheter was removed on postoperative day 1 with a median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p<0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across the study period when compared to baseline (p<0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5%
Conclusion
Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.
Introduction
Lower urinary tract symptoms (LUTS) are common in the aging population of men and are often a result of benign prostatic hyperplasia (BPH) [1]. In cases where medical management fails to adequately address LUTS or urinary retention caused by BPH, surgical intervention is recommended. Transurethral resection of the prostate (TURP) remains the surgical standard in prostates between 30 and 80 ccs [2] given its established success rate and global availability. However, TURP has been associated with noticeable morbidity such as bleeding [3]. Consequently, efforts have been made to develop technologies with superior hemostatic properties.
Greenlight photo-selective vaporization of the prostate (GL-PVP) is an established alternative to TURP and has demonstrated that it is a safe option in men requiring anticoagulation therapy. In addition, current EAU guidelines provide a strong recommendation for PVP as a safe alternative for TURP in prostate volumes between 30 and 80 ccs [1].
To ascertain the global state of GL-PVP in the wide array of available BPH surgical modalities, the Global Greenlight Group (GGG) database was created through the collaboration of eight experienced surgeons in seven international centers within North America, South America, and Europe. The aim was to provide a well-represented real-world characterization of the safety and effectiveness of GL-PVP.
Herein, through retrospective review of a pooled international database, we provide a descriptive analysis of preoperative, and perioperative data, surgical complications, and functional outcomes found within the GGG database.
In conclusion, our multicenter experience demonstrated very few major operative complications and a low reintervention rate. GL-PVP using the XPS-180 W system is a safe and effective treatment for LUTS secondary to BPH and can provide durable outcomes.
Introduction
Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers.
Methods
Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications.
Results
At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64–77), 64 (47–90), 3.1 ng/mL (1.8–6), and 22 (19–27), respectively. Median lasing and operative time were 34 (23–48) and 62 min (46–85), respectively. Median energy use was 250.0 kJ (168.4–367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, the catheter was removed on postoperative day 1 with a median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p<0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across the study period when compared to baseline (p<0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5%
Conclusion
Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.
Introduction
Lower urinary tract symptoms (LUTS) are common in the aging population of men and are often a result of benign prostatic hyperplasia (BPH) [1]. In cases where medical management fails to adequately address LUTS or urinary retention caused by BPH, surgical intervention is recommended. Transurethral resection of the prostate (TURP) remains the surgical standard in prostates between 30 and 80 ccs [2] given its established success rate and global availability. However, TURP has been associated with noticeable morbidity such as bleeding [3]. Consequently, efforts have been made to develop technologies with superior hemostatic properties.
Greenlight photo-selective vaporization of the prostate (GL-PVP) is an established alternative to TURP and has demonstrated that it is a safe option in men requiring anticoagulation therapy. In addition, current EAU guidelines provide a strong recommendation for PVP as a safe alternative for TURP in prostate volumes between 30 and 80 ccs [1].
To ascertain the global state of GL-PVP in the wide array of available BPH surgical modalities, the Global Greenlight Group (GGG) database was created through the collaboration of eight experienced surgeons in seven international centers within North America, South America, and Europe. The aim was to provide a well-represented real-world characterization of the safety and effectiveness of GL-PVP.
Herein, through retrospective review of a pooled international database, we provide a descriptive analysis of preoperative, and perioperative data, surgical complications, and functional outcomes found within the GGG database.
In conclusion, our multicenter experience demonstrated very few major operative complications and a low reintervention rate. GL-PVP using the XPS-180 W system is a safe and effective treatment for LUTS secondary to BPH and can provide durable outcomes.
