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Lichy I, Law K, Tholomier C, Nguyen DD, Sadri I, Bouhadana D, Couture F, Zakaria AS, Bhojani N, Zorn KC, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Reimann M, Cash H. Global experience and progress in GreenLight-XPS 180-Watt photoselective vaporization of the prostate. World J Urol 2022; 40:1513-1522. [PMID: 35499590 PMCID: PMC9166849 DOI: 10.1007/s00345-022-03997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. METHODS 3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011-2019) and prostate volume (PV) group (< 80 ml vs. 80-150 ml vs. > 150 ml). RESULTS The median age was 70 years (interquartile range 64-77), the median PV was 64 ml (IQR 47-90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45-83) and LT was 33 min (IQR 23-46). Median energy use was 253 kJ (IQR 170-375) with an energy density of 3.94 kJ/ml (IQR 2.94-5.02). The relative probability of perioperative AEs decreased by 17% each year (p < 0.001). The relative probability of perioperative transfusion dropped significantly from 2% in 2011 to 0% in 2019 (p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (p > 0.001). CONCLUSION These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience.
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Affiliation(s)
- Isabel Lichy
- Department of Urology, Charité–University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Kyle Law
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Côme Tholomier
- Division of Urology, Department of Surgery, McGill University, Montreal, QC Canada
| | - David-Dan Nguyen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Iman Sadri
- Division of Urology, Department of Surgery, McGill University, Montreal, QC Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Félix Couture
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Ahmed S. Zakaria
- Division of Urology, Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, ON Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Kevin C. Zorn
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees France
| | - Dean Elterman
- Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, ON Canada
| | - Maximilian Reimann
- Department of Urology, Charité–University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany
- Department of Urology, University of Magdeburg, Magdeburg, Germany
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
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Nguyen DD, Sadri I, Law K, Bhojani N, Elterman DS, Zakaria AS, Arezki A, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database. World J Urol 2021; 39:3881-3889. [PMID: 33388918 DOI: 10.1007/s00345-020-03529-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Previous analyses of the impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180 W XPS GreenLight PVP using a large international database. METHODS Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score. RESULTS A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22-10.23; p < 0.01) minutes and 2.90 (95% CI 1.02-4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11-3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6 months which was 46.51 ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes. CONCLUSIONS Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.
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Affiliation(s)
| | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Kyle Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Ahmed S Zakaria
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Adel Arezki
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Modena, Italy
| | | | | | | | | | - Hannes Cash
- Department of Urology, Charite-Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
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Abstract
PURPOSE OF REVIEW GreenLight photoselective vaporization (GL-PV) is now established in the treatment of benign prostatic enlargement. The present review outlines the available technical armamentarium and summarizes the current best evidence on functional and safety outcomes. Moreover, future technical developments and refinements are presented. RECENT FINDINGS GL-PV has evolved to be the most commonly performed procedure, second to conventional transurethral resection of the prostate (TURP) for surgical management of benign prostatic obstruction (BPO). On the basis of the data published in the randomized controlled Goliath study, GL-PV with 180-W technology is noninferior in terms of functional outcomes compared with TURP considering short and intermediate follow-up with a complication-free rate of around 80% after 24 months.The ongoing push towards high-power lasers can be explained by their more effective tissue ablative effect, leading to shorter operating times. Comparative analysis between high-power and low-power laser systems demonstrated similar retreatment rates and most institutions are, therefore, now performing 180-W GL-PV.Performed as an outpatient procedure, GL-PV is cost-effective with a low hospital re-admission rate. Plasma kinetic vaporization of the prostate (PKVP) has recently emerged as a potential contender in the field; also GreenLight enucleation of the prostate (GreenLEP) might be even more effective than GL-PV. SUMMARY GL-PV appears to be a well tolerated surgical alternative for patients suffering from BPO. Long-term follow-up data from 120-W and 180-W laser systems are still pending. Potential competitors have recently been brought to the market and further trials and long-term data will show, whether GL-PV will stand the test of time. Regardless of technical specifications, surgeon's experience remains essential to achieve good functional and safety outcomes.
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Bodokh Y, Treacy PJ, Imbert de la Phalecque L, Durand M. Does Prostate Median Lobe Really Matter for GreenLight HPS Laser Photovaporization of the Prostate. J Endourol Case Rep 2018; 4:169-172. [PMID: 30426077 PMCID: PMC6225076 DOI: 10.1089/cren.2018.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Benign prostatic hyperplasia (BPH) is a common pathology in elderly patients, inducing lower urinary tract symptoms. The treatment of BPH is first a medical option, then a surgical treatment, either by endoscopy or open surgery. We here report a case of GreenLight HPS™ laser photovaporization (PV) with an impaired maintenance of median lobe postoperatively, unimportant on functional results. Case Presentation: A 68-year-old man presented with lower urinary tract symptoms in the last 2 years, treated first by medicine with good response. On digital rectal examination, the enlarged prostate was homogeneous and regular. International Prostate Symptom Score (IPSS) was 30/35, Incontinence Quality of Life (iQol) 6/6, and International Index of Erectile Function 5 14/25 with regular sexual activity. Transrectal ultrasound (TRUS) reported BPH of 62 g with a median lobe of 6 g protruding into the bladder. At uroflowmetry, maximum urinary flow rate (Qmax) was 8 mL/s for 90 cc void volume and 20 cc postvoid residual. After failure of medical treatment, we offered a surgical treatment option by laser therapy using the 180W XPS GreenLight™. At 1-month follow-up, functional outcomes were improved with a Qmax of 11 mL/s, postvoiding residual volume 0 cc, IPSS 12/35, and iQol 2/6. At 3-month follow-up, outcomes still improved, although the TRUS reported a prostate volume of 30 g with a persistent median lobe. Conclusion: Impaired maintenance of median lobe after GreenLight laser PV does not seem to affect functional results. This case report opens the way for a new therapeutic strategy for patients according to their prostate anatomy. A randomized clinical trial could be done about surgical treatment for patient BPH according to prostate volume and anatomy.
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Affiliation(s)
- Yohan Bodokh
- Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University, Nice, France
| | - Patrick Julien Treacy
- Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University, Nice, France
| | | | - Matthieu Durand
- Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University, Nice, France.,Department of Urology MSSM, New York City, New York.,INSERM, U1189, ONCO-THAI, Lille, France
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Pascoe C, Ow D, Perera M, Woo HH, Jack G, Lawrentschuk N. Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review. Transl Androl Urol 2017; 6:S133-S141. [PMID: 28791232 PMCID: PMC5522804 DOI: 10.21037/tau.2017.05.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.
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Affiliation(s)
- Claire Pascoe
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Darren Ow
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Marlon Perera
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
| | - Greg Jack
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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GreenLight HPS 120-W laser photoselective vaporization of the prostate as early therapy for acute urinary retention in advanced prostate cancer patients. Lasers Med Sci 2013; 28:1339-44. [PMID: 23283570 DOI: 10.1007/s10103-012-1252-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/18/2012] [Indexed: 12/12/2022]
Abstract
We evaluate the safety, efficacy, and oncological outcomes of early palliative photoselective vaporization of the prostate (PVP) by GreenLight high-performance system (HPS) 120-W laser in patients with acute urinary retention (AUR) induced by advanced prostate cancer (PCa). A total of 39 advanced PCa patients with AUR who underwent PVP were enrolled in this retrospective study. Baseline parameters, perioperative, and postoperative complications were reviewed. The functional outcomes were evaluated at 1, 3, 6, and 12 months after surgery using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, peak urinary flow rate (Q max), and postvoid residual urine volume (PVR). At baseline, mean age was 72.8 ± 6.8 years and mean prostate-specific antigen (PSA) level was 45.2 ± 26.9 ng/mL. The average energy consumed was 171.2 ± 72.3 kJ during a mean operative time of 46.3 ± 13.7 min. Mean catheterization duration was 3.3 ± 0.8 days. Mean hospitalization time was 5.2 ± 0.5 days. Compared with the preoperative values, there were significant continuous improvement in IPSS, QoL score, Q max, and PVR at all time points of follow-up. The mean PSA nadir was 0.33 ± 0.15 ng/mL and the mean time to PSA nadir was 10.3 ± 2.5 months. Nine patients (23 %) eventually developed hormone refractory prostate cancer. No patient experienced severe intraoperative and postoperative complications. Our preliminary investigation shows that GreenLight HPS 120-W laser PVP is a safe and effective treatment for advanced PCa patients with AUR. Patients may obtain some oncological benefits from tumor cytoreduction by early palliative PVP.
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