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Ajib K, Mansour M, Zanaty M, Alnazari M, Hueber PA, Meskawi M, Valdivieso R, Tholomier C, Pradere B, Misrai V, Elterman D, Zorn KC. Photoselective vaporization of the prostate with the 180-W XPS-Greenlight laser: Five-year experience of safety, efficiency, and functional outcomes. Can Urol Assoc J 2018; 12:E318-E324. [PMID: 29603912 DOI: 10.5489/cuaj.4895] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH). However, photoselective vaporization of the prostate (PVP) has gained widespread global acceptance in national guidelines as a safe and effective alternative option. Nevertheless, further evidence is required to assess the durability of Greenlight PVP. Herein, we report our five years of PVP experience with the Greenlight 180W XPS laser system. METHODS A retrospective analysis was conducted on a prospectively gathered database of 370 consecutively included patients who underwent PVP using Greenlight XPS-180 W laser system (Boston Scientific, Boston, MA, U.S.) performed by a single experienced laser surgeon between 2011 and 2016. Preoperative characteristics, intervention parameters, postoperative functional, uroflowmetry outcomes, and complications were collected. Outcomes are reported over a period of five years. RESULTS Mean age was 68 years, with a mean prostate volume of 78.8 cc (95% confidence interval [CI] 70.9-78.7]). The mean followup was 59.4 months (55.4-63.5). Mean energy, operative time, and energy/cc were 270.2 kJ (255.2-285.2), 62.7 minutes (59.6-65.7), and 3.7 kJ/cc (3.6-3.9), respectively. Compared to preoperative values, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual (PVR) parameters were significantly improved and sustained over the five postoperative years. Of note, only 66 patients (out of 370) had a complete five-year followup. Prostate-specific antigen (PSA) reached nadir at one year, with a drop of 67% from the mean preoperative value of 6.2 ng/mL. Mean IPSS nadir was reached at three years, with a drop of 80.4% (-21.1 points). Similarly, mean quality of life (QoL) score dropped by 82.8% after three years (preoperative mean of 4.7). With respect to mean Qmax, there was an increase by 72.7% (+14.7 mL/s) at one year, reaching the value of 19.9 mL/s. Moreover, mean PVR was 32.8 mL at four years compared to 345 mL preoperatively. At five years followup, PSA, IPSS, QoL, and PVR dropped by 59.7% (3.7 ng/mL), 75.2% (19.7 points), 78.72% (3.7 points), and 84.4% (291.3 mL), respectively. Qmax increased by 12.9 mL/s. Clavien complication rates were low, with bladder neck stenosis observed in seven (1.6%) men. During the five-year followup, only four patients (1%) required BPH surgical re-intervention. CONCLUSIONS This is the first long-term reporting of Greenlight XPS-180W laser system. In experienced hands, the observed outcomes appear to demonstrate that Greenlight XPS-180 W laser system is safe, efficacious, and durable for the treatment of bladder outlet obstruction (BOO) secondary to BPH.
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Affiliation(s)
- Khaled Ajib
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Mila Mansour
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marc Zanaty
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Mansour Alnazari
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Malek Meskawi
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Roger Valdivieso
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Come Tholomier
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Department of Urology, McGill University, Montreal, QC, Canada
| | - Benjamin Pradere
- Department of Urology, Centre Hospitalier Universitaire, Tours, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Azizi M, Tholomier C, Meskawi M, Hueber PA, Valdivieso RF, Alenizi AM, Rajih E, Zanaty M, Hai MA, Gonzalez RR, Eure GR, Kriteman LS, Misrai V, Zorn KC. Safety, Perioperative, and Early Functional Outcomes of Vapor Incision Technique Using the GreenLight XPS 180 W System: Direct Comparison with Photoselective Vaporization of the Prostate. J Endourol 2017; 31:43-49. [DOI: 10.1089/end.2016.0474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Mounsif Azizi
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Côme Tholomier
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Malek Meskawi
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Roger F. Valdivieso
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | | | - Emad Rajih
- Department of Urology, Taibah University, Madina, Saudi Arabia
| | - Marc Zanaty
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Mahmood A. Hai
- Department of Urology, Comprehensive Urology, Westland, Michigan
| | | | - Gregg R. Eure
- Department of Urology, Urology of Virginia, Virginia Beach, Virginia
| | | | | | - Kevin C. Zorn
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
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Pariser JJ, Famakinwa OJ, Pearce SM, Chung DE. High-power thulium laser vaporization of the prostate: short-term outcomes of safety and effectiveness. J Endourol 2014; 28:1357-62. [PMID: 24936718 DOI: 10.1089/end.2014.0336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The thulium laser was introduced in 2005 for the treatment of benign prostatic hyperplasia (BPH). Enucleation studies from outside North America show comparable efficacy and lower morbidity to transurethral resection of the prostate. A few studies exist describing outcomes of vaporization, the most commonly used technique for urologists. We present our 3-month outcomes of thulium laser vaporization of the prostate (ThuVP). MATERIALS AND METHODS From December 2010 to October 2013, 68 men underwent ThuVP using the 150 W CyberTM(®). Data were collected on demographics, comorbidities, intraoperative measures, complications, serum parameters, maximum flow rate (Qmax), postvoid residual (PVR), International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, and prostate-specific antigen. Patients were evaluated at 1 week, 1 month, and 3 months postoperatively. Nine patients were excluded for known prostate cancer. RESULTS The mean age was 66±10 years, with a mean prostate size of 57±30 mL. At baseline, the mean IPSS was 19.9±8.0, QoL score was 4.5±1.1, Qmax was 5.2±4.5 mL/sec, and PVR was 220±397 mL. The mean laser time was 35±18 minutes, and energy used was 234±139 kJ. Forty-seven (78%) patients were discharged the day of surgery. No blood transfusions were administered with a mean drop in hemoglobin of 0.7±0.8 g/dL (p<0.05). There were no Clavien grade≥III complications within 30 days of surgery. Six (10%) patients were diagnosed with urinary tract infection. Significant improvements from baseline were seen in Qmax, PVR, IPSS, and QoL score. All 15 patients who were in retention were voiding at the last follow-up. CONCLUSIONS Thulium laser vaporization of the prostate appears to be a safe and effective outpatient technique for the treatment of BPH with durable outcomes at 3 months.
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