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Gautier B, Chaker K, Schneider M, Obringer L, Jung JL. [Assessment of energy density during laser photoselective vaporisation of the prostate: A retrospective monocentric study]. Prog Urol 2021; 31:584-590. [PMID: 33941459 DOI: 10.1016/j.purol.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/02/2020] [Accepted: 10/30/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Greenlight XPS-180W® (AMS, San José, USA) photoselective vaporisation of the prostate (PVP) is considered as an alternative to transurethral resection of the prostate. The objective of this study was to assess the effect of energy density applied on adenoma during PVP treatment for benign prostate hyperplasia (BPH) on postoperative outcomes. METHODS A single-centre retrospective study has been conducted in the department of Urology of Colmar Hospital, in patients with symptomatic BPH, treated by PVP, between January 2016 and January 2019. Patients were stratified into two groups according to energy delivered and prostate volume as determined preoperatively: Low density (<4kJ/mL) and high density (>4kJ/mL). Perioperative complications, PSA evolution and functional outcomes (International Prostate Symptom Score, quality of life, maximum urinary flow rate, post-void residual urine volume) were compared with a minimal delay of 6 months. The retreatment rate was similar in the two groups. RESULTS A total of 215 patients were included with median follow-up of 25 months. High energy density was associated with less glandular volume. There were no statistically significant differences between the two groups concerning the perioperative complications and the functional outcomes. The postoperative reduction of the PSA level was more significant in the high-energy group (41% vs. 28%, P=0.03). CONCLUSION The perioperative complications and functional outcomes of PVP with Greenlight XPS-180W® laser are equivalent depending on the energy density delivered. The greater decrease in postoperative PSA for high-energy density could nevertheless suggest better quality tissue destruction. LEVEL OF PROOF 3.
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Affiliation(s)
- B Gautier
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France.
| | - K Chaker
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France
| | - M Schneider
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France
| | - L Obringer
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France
| | - J L Jung
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France
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Furusawa J, Yamada Y, Soga N, Kuromatsu I. Optimal Monitoring of Prostate-Specific Antigen Detects Prostate Cancer at the Localized Stage after Photoselective Vaporization for Benign Prostatic Hyperplasia. Curr Urol 2019; 12:147-152. [PMID: 31316323 DOI: 10.1159/000489433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/24/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Photoselective vaporization of the prostate (PVP) does not provide prostate tissue for pathologic analysis. Here, we carried out early monitoring for prostate cancer by measuring prostate-specific antigen (PSA) levels and assessing clinicopathological features after PVP. Materials and Methods Patients (n = 800) who underwent PVP and were followed-up for more than 12 months were analyzed retrospectively. After PVP, PSA levels were measured at 3 and 12 months and each year thereafter. Prostate biopsies were performed when PSA levels increased continuously. We assessed the characteristics of patients diagnosed with prostate cancer. Results The mean follow-up period was 49 months. After PVP, 54 patients underwent biopsies, and 23 patients were diagnosed with prostate cancer. Overall, 10, 10, and 3 patients had clinical stage T1c, T2a, and T2b disease, respectively, and there were no cases of stage T2c disease or greater. Conclusions We found that it was possible to diagnose prostate cancer at a localized stage under our optimal PSA monitoring schedule before and after PVP.
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Affiliation(s)
- Jun Furusawa
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Yamada
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Norihito Soga
- Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Isao Kuromatsu
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan
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Castellan P, Marchioni M, Rizzoli A, Di Nicola M, Porfilio I, Ghahhari J, Greco F, Schips L, Cindolo L. The Surgical Experience Influences the Safety and Efficacy of Photovaporization of Prostate with 180-W XPS GreenLight Laser: Comparison Between Novices vs Expert Surgeons Learning Curves. J Endourol 2018; 32:1071-1077. [PMID: 30226409 DOI: 10.1089/end.2018.0437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess the extent to which surgical experience can affect perioperative and functional outcomes after photoselective vaporization of the prostate (PVP) with 180W XPX GreenLight laser in patients with lower urinary tract symptoms secondary to benign prostatic obstruction (BPO). MATERIALS AND METHODS Data from 291 consecutive patients with symptomatic BPO (median follow-up 12 m) were collected and analyzed. Patients were treated at 2 different institutions by 2 expert (G1, n = 182) and 2 novice (G2, n = 109) transurethral prostate surgeons (February 2013 - March 2017) and underwent standard or anatomical PVP depending on surgeons' preferences. Patients' characteristics, perioperative and functional outcomes were compared using the chi-square and Mann-Whitney U tests. Patients' satisfaction was measured using the Patient Global Impression of Improvement (PGI-I) score. Learning curves were analyzed based on changes in quantitative parameters: surgery time, lasing/operative time, and energy delivered (kJ). RESULTS Patients' baseline characteristics, perioperative data and PGI-I score were similar. Overall the complication rates showed better trends for G1. Serum prostate-specific antigen levels, maximum flow rate, and International Prostatic Symptoms Score improved in both groups, with perceived improvements greater in G2 (p < 0.006). Lasing time/operative time ratio showed greater evolution for G1 than G2 (0.50:IQR 0.38-0.60 vs 0.46:IQR 0.34-0.58, respectively)(p = 0.201). A major increase in energy delivery for G2 was achieved within the first 50 procedures, whereas more than 100 iterations were needed for G1 to reach LT/OT >60%. CONCLUSION Surgeons' background and expertise appear to affect outcomes over the learning curve, with roughly similar perioperative and functional results.
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Affiliation(s)
| | | | - Ambra Rizzoli
- 2 Department of Urology, University "G. d'Annunzio" , Chieti, Italy
| | - Marta Di Nicola
- 3 Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University "G.d'Annunzio," Chieti, Italy
| | - Italo Porfilio
- 4 Division of Hygiene, Epidemiology and Public Health, Department of Medicine and Science of Aging, University "G. d'Annunzio," Chieti, Italy
| | - Jamil Ghahhari
- 2 Department of Urology, University "G. d'Annunzio" , Chieti, Italy
| | - Francesco Greco
- 5 Department of Urology, Humanitas Gavazzeni , Bergamo, Italy
| | - Luigi Schips
- 1 Department of Urology, ASL02 Abruzzo , Chieti, Italy .,2 Department of Urology, University "G. d'Annunzio" , Chieti, Italy
| | - Luca Cindolo
- 1 Department of Urology, ASL02 Abruzzo , Chieti, Italy
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Valdivieso R, Hueber PA, Meskawi M, Belleville E, Ajib K, Bruyere F, Te AE, Chughtai B, Elterman D, Misrai V, Zorn KC. Multicentre international experience of 532-nm laser photoselective vaporization with GreenLight XPS in men with very large prostates. BJU Int 2018; 122:873-878. [PMID: 29570929 DOI: 10.1111/bju.14208] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe peri-operative results, functional outcomes and complications of laser photoselective vaporization, using the GreenLight system, of prostate glands ≥200 mL in volume. METHODS Retrospective analysis of a prospectively maintained multicentre database was performed to select a subgroup of patients with very large prostates (volume ≥200 mL) treated with the GreenLight XPS laser. A subgroup of patients with prostate volumes 100-200 mL was used for comparison. International Prostate Symptom Score, maximum urinary flow rate, postvoid residual urine volume and prostate-specific antigen levels were measured at 6, 12, 24, 36 and 48 months. Durability was evaluated using benign prostatic hyperplasia re-treatment rate at 12, 24 and 36 months. Additionally, complications were recorded using Clavien-Dindo classification. RESULTS A total of 33 patients (38%) had prostates ≥200 mL. Baseline characteristics were similar between patients with prostates ≥200 mL and those with prostates 100-200 mL. Patients with very large prostates (≥200 mL) had longer operating times (129 vs 93 min), less energy delivered, a greater number of fibres used (3 vs 2) and a higher conversion rate to transurethral resection of the prostate (16% vs 4%). In terms of complications and functional outcomes, we did not find any differences between the groups. Retreatment rate was also comparable. CONCLUSIONS Our results show that PVP GreenLight XPS-180W is an acceptable technique for very large prostates (≥200 mL); however, operating times, energy delivery, fibres used and conversion to TURP are a concern in this particular subgroup. This should be used for patient counselling and surgery planning.
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Affiliation(s)
- Roger Valdivieso
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Pierre-Alain Hueber
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Malek Meskawi
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Eric Belleville
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Khaled Ajib
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Alexis E Te
- Department of Urology, Cornell University, New York, NY, USA
| | - Bilal Chughtai
- Department of Urology, Cornell University, New York, NY, USA
| | - Dean Elterman
- Department of Urology, University of Toronto, Toronto, ON, Canada
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulousse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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Reimann M, Fishman N, Almedom Z, Lichy I, Buckendahl J, Steiner U, Friedersdorff F, Busch J, Fuller TF, Miller K, Hinz S, Cash H. Perioperative Changes and Progress in Photoselective Vaporization of the Prostate with GreenLight XPS 180 W System: A Single Center Experience. Urol Int 2018; 100:463-469. [PMID: 29621785 DOI: 10.1159/000487958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/23/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The study aimed to evaluate progression of GreenLight-XPS 180 W photoselective vaporization of the prostate (GL-XPS) with respect to effectiveness, efficacy, and safety over time at a tertiary referral high volume center. METHODS The retrospective study included 375 men who underwent GL-XPS for symptomatic benign prostate obstruction (BPO) between June 2010 and February 2015. Primary outcome measurements were operation time (OT; min) and effective laser time (LT; min of OT) analyzed with regard to prostatic volume (PV; mL) (group 1 <40 mL up to 4 >80 mL in 20 mL steps) and the year of surgery (2010-2015). RESULTS The median age was 72 years (range 64-79), the median PV was 58 mL (range 33-98) and the median PV increased from 42 mL in 2012 to 80 mL in 2015. The OT and LT clearly correlated with the PV, being doubled for glands of median 95 mL compared to median 30 mL while the applied laser energy per LT likewise steadily increased. Overall, both OT and LT could be significantly reduced each year by 37% (OT; p < 0.05) and 36% (LT; p < 0.05) within 5 years. The hospital stay (days) and catheterization time (days) remained constant, without any changes over time. The overall complication rate (Clavien-Dindo >2) ranged from 36 to 15% between 2010 and 2015. The pre (median 22 + 4) and postoperative International Prostate Symptom Score-Quality of Life (median 5 + 1) showed a sufficient reduction in symptomatic BPO. CONCLUSION GL-XPS is a safe and effective surgical method for symptomatic BPO. Our single center experience showed a significant improvement of both OT and effective LT within 5 years whilst maintaining stable low complication rate and high patient satisfaction.
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Affiliation(s)
- Maximilian Reimann
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Nikita Fishman
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Zenai Almedom
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Isabel Lichy
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - John Buckendahl
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Ursula Steiner
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Jonas Busch
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Tom Florian Fuller
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
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Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc). World J Urol 2017; 35:1603-1609. [PMID: 28229211 DOI: 10.1007/s00345-017-2007-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the outcomes and durability of photoselective vaporization of the prostate (PVP) using the XPS-180 system in patients with a large prostate volume (PV) > 100 cc at 4 years of follow-up in a large, multicenter experience. METHODS 438 men with pre-operative transrectal ultrasound (TRUS) PV > 100 cc were treated in eight experienced centers in Canada, USA, and in France with the Greenlight XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, postvoid residual (PVR), and prostate-specific antigen (PSA) were measured at 6, 12, 24, 36, and 48 months. Durability was evaluated using BPH retreatment rate at 12, 24, and 36 months. RESULTS Median PV and PSA were 121 cc and 6.3 ng/dl. Indwelling catheter at the time of surgery was observed in 37% of men. Median operative, laser time, and energy applied were 90 min, 55 min, and 422 kJ, respectively. Median energy delivery was 3.4 kJ/cc of prostate per case. Outpatient surgery was feasible with median length of stay at 24 h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months. Moreover, surgical BPH retreatment rates were 5.4 and 9.3% at 24 and 36 months. Interestingly, characteristics of retreated men include: energy delivery 2.4 vs. 3.4 kJ/cc of prostate (p = 0.02) and PSA reduction at 12 months 26 vs. 51% (p = 0.02). CONCLUSIONS PVP using Greenlight XPS-180W can potentially provide durable improvements with regard to functional outcomes at 4 years. However, rising retreatment rates after 3 years is of concern. This highlights the imperative need of utilizing a standardized surgical technique (enucleation-like-defect) and an optimal energy density >3KJ/cc.
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Chughtai B, Thomas D, Misrai V, Te A, Kaplan S, Zorn KC. A Plea for the Development of New Benign Prostatic Obstruction Follow-up Guidelines. Urology 2016; 99:1-2. [PMID: 27562200 DOI: 10.1016/j.urology.2016.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
| | - Dominique Thomas
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Steven Kaplan
- Department of Urology, Mount Sinai Hospital, New York, NY
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, Canada
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Stone BV, Chughtai B, Forde JC, Tam AW, Lewicki P, Te AE. Safety and Efficacy of GreenLight XPS Laser Vapoenucleation in Prostates Measuring Over 150 mL. J Endourol 2016; 30:906-12. [PMID: 27203515 DOI: 10.1089/end.2016.0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The GreenLight™ XPS Laser System (GL-XPS) is a safe and efficacious treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH), but there is limited evidence on its use in prostates over 150 mL. We demonstrate the safety and efficacy of the GL-XPS system using a vapoenucleation technique in prostate glands measuring over 150 mL. METHODS We prospectively collected data on all consecutive patients with prostates measuring over 150 mL on transrectal ultrasound treated with the GL-XPS (AMS, Inc., Minnetonka, MN) at a tertiary referral center from September 2011 to October 2015. Data collected include prostate volume, International Prostate Symptom Score (IPSS) and quality of life (QoL) scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate-specific antigen, complications, and reintervention rates. RESULTS Seventy male patients with a median prostate size of 202 mL (range 152-376 mL) were included. There were 41 patients (59%) in preoperative urinary retention with an indwelling catheter preoperatively. Thirty-seven (53%) patients were American Society of Anesthesiologists (ASA) class 2 and 33 (47%) were class 3. Median operative time was 180 minutes, laser time 97 minutes, energy utilization 674 kJ, and energy density 3.3 kJ/mL, with median 3 fibers used per case. Median length of stay and length of catheterization were 1 day. IPSS and QoL scores demonstrated significant improvements from baseline at all endpoints, improving from 16 to 3.5 and from 4 to 1 at 24 months, respectively (p = 0.001). At 12 months, Qmax and PVR improved from 10.1 to 22.4 mL/s (p = 0.043) and from 84 to 31.4 mL (p = 0.015), respectively. Retreatment was required in two patients (2.9%). CONCLUSION GL-XPS vapoenucleation provided durable subjective and objective improvements in symptoms and voiding parameters, with no serious adverse events in men with prostates >150 mL.
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Affiliation(s)
- Benjamin V Stone
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital , New York, New York
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital , New York, New York
| | - James C Forde
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital , New York, New York
| | - Andrew W Tam
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital , New York, New York
| | - Patrick Lewicki
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital , New York, New York
| | - Alexis E Te
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital , New York, New York
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Valdivieso R, Meyer CP, Hueber PA, Meskawi M, Alenizi AM, Azizi M, Trinh QD, Misrai V, Rutman M, Te AE, Chughtai B, Barber NJ, Emara AM, Munver R, Zorn KC. Assessment of energy density usage during 180W lithium triborate laser photoselective vaporization of the prostate for benign prostatic hyperplasia. Is there an optimum amount of kilo-Joules per gram of prostate? BJU Int 2016; 118:633-40. [DOI: 10.1111/bju.13479] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Roger Valdivieso
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Christian P Meyer
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Pierre-Alain Hueber
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Malek Meskawi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Abdullah M. Alenizi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Mounsif Azizi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Vincent Misrai
- Department of Urology; Clinique Pasteur Toulouse; Toulouse France
| | - Matthew Rutman
- Department of Urology; Columbia University; New York NY USA
| | - Alexis E. Te
- Department of Urology; Cornell University; New York NY USA
| | - Bilal Chughtai
- Department of Urology; Cornell University; New York NY USA
| | - Neil J. Barber
- Department of Urology; Frimley Park Hospital; Frimley Surrey UK
| | - Amr M. Emara
- Department of Urology; Frimley Park Hospital; Frimley Surrey UK
| | - Ravi Munver
- Department of Urology; Hackensack University Medical Center; Hackensack NJ USA
| | - Kevin C. Zorn
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
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de la Rosette J, Elhilali M, Naito S, Unal D, Razvi H, Liatsikos E, Bachmann A, Tubaro A, Alivizatos G, Mak SK, Badlani G, Eltahawy E, Wong C, Telich Vidal M, Te A, d'Ancona F, Arum CJ, Gutierrez J. Clinical Research Office of the Endourological Society Global GreenLight Laser Study: Outcomes from a contemporary series of 713 patients. Int J Urol 2015; 22:1124-30. [DOI: 10.1111/iju.12906] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jean de la Rosette
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
| | - Mostafa Elhilali
- Division of Urology; Department of Surgery; McGill University Health Centre; Montreal Quebec Canada
| | - Seiji Naito
- Department of Urology; Harasanshin Hospital; Kyushu University; Fukuoka Japan
| | - Dogan Unal
- Department of Urology; Faculty of Medicine, Hacettepe University; Ankara Turkey
| | - Hassan Razvi
- Division of Urology; Department of Surgery; Western University; London Ontario Canada
| | | | | | - Andrea Tubaro
- Department of Urology; Sant'Andrea Hospital; Rome Italy
| | | | - Siu King Mak
- Department of Surgery; North District Hospital; Hong Kong China
| | - Gopal Badlani
- Department of Urology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Ehab Eltahawy
- Department of Urology; University of Arkansas for Medical Sciences; Little Rock Arkansas USA
| | - Carson Wong
- Division of Urology; University Hospitals Ahuja Medical Center; Beachwood Ohio USA
- Center for Minimally Invasive and Robotic Surgery; University Hospitals Parma Medical Center; Parma Ohio USA
- Minimally Invasive and Robotic Surgery; SouthWest Urology; LLC; Cleveland Ohio USA
| | | | - Alexis Te
- Department of Urology; Weill Medical College of Cornell University; New York New York USA
| | - Frank d'Ancona
- Department of Urology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Carl-Jørgen Arum
- Department of Urology; St. Olavs University Hospital; Trondheim Norway
| | - Jorge Gutierrez
- Department of Urology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
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Hueber PA, Bienz MN, Valdivieso R, Lavigueur-Blouin H, Misrai V, Rutman M, Te AE, Chughtai B, Barber NJ, Emara AM, Munver R, Trinh QD, Zorn KC. Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia Using the 180 Watt System: Multicenter Study of the Impact of Prostate Size on Safety and Outcomes. J Urol 2015; 194:462-9. [PMID: 25849599 DOI: 10.1016/j.juro.2015.03.113] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated photoselective vaporization of the prostate using the GreenLight™ XPS™ 180 W system for benign prostatic hyperplasia treatment in a large multi-institutional cohort at 2 years. We particularly examined safety, outcomes and the re-treatment rate in larger prostates, defined as a prostate volume of 80 cc or greater, to assess the potential of photoselective vaporization of the prostate as a size independent procedure. MATERIALS AND METHODS A total of 1,196 patients were treated at 6 international centers in Canada, the United States, France and England. All parameters were collected retrospectively, including complications, I-PSS, maximum urinary flow rate, post-void residual urine, prostate volume, prostate specific antigen and the endoscopic re-intervention rate. Subgroup stratified comparative analysis was performed according to preoperative prostate volume less than 80 vs 80 cc or greater on transrectal ultrasound. RESULTS Median prostate size was 50 cc in 387 patients and 108 cc in 741 in the prostate volume groups less than 80 and 80 cc or greater, respectively. The rate of conversion to transurethral prostate resection was significantly higher in the 80 cc or greater group than in the less than 80 cc group (8.4% vs 0.6%, p <0.01). I-PSS, quality of life score, maximum urinary flow rate and post-void residual urine were significantly improved compared to baseline at 6, 12 and 24 months of followup without significant differences between the prostate size groups. The re-treatment rate at 2 years reported in 5 of 411 patients was associated with the delivery of decreased energy density (2.1 vs 4.4 kJ/cc) in the group without re-treatment. CONCLUSIONS Photoselective vaporization of the prostate using the XPS 180 W system is safe and efficacious, providing durable improvement in functional outcomes at 2 years independent of prostate size when treated with sufficient energy.
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Affiliation(s)
- Pierre-Alain Hueber
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Nicolas Bienz
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Roger Valdivieso
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Hugo Lavigueur-Blouin
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur Toulouse, Toulouse, France
| | - Matthew Rutman
- Department of Urology, Columbia University, New York, New York
| | - Alexis E Te
- Department of Urology, Cornell University, New York, New York
| | - Bilal Chughtai
- Department of Urology, Cornell University, New York, New York
| | - Neil J Barber
- Department of Urology, Frimley Park Hospital, Frimley, United Kingdom
| | - Amr M Emara
- Department of Urology, Frimley Park Hospital, Frimley, United Kingdom
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, New Jersey
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada.
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