Prostatic Enucleovaporization Using GreenLight™ Laser for Treatment of Benign Prostatic Hyperplasia: 12-Month Results

Abstract

Introduction: Treatment options for benign prostatic hyperplasia (BPH) include an open approach, transurethral resection of the prostate (TURP), and newer energy-driven modalities. TURP has been the preferred technique for many decades; however, it carries a significant risk of bleeding, hyponatremia, and reoperation.1,2 Newer modalities are growing in popularity but face limitations on prostate size and risk causing irritative bladder symptoms.3 Enucleovaporization of the prostate (EVP) using the Greenlight™ laser (American Medical Systems, Minnetonka, MN) is a new technique that is suitable for larger prostates while potentially minimizing postoperative morbidity. We present our initial experience with the first 10 consecutive patients to undergo Greenlight EVP by a single surgeon at a large academic medical center with 1 year follow-up. Materials and Methods: A retrospective review was conducted on 10 consecutive patients undergoing EVP by a single surgeon between March 2013 and March 2014. Descriptive statistical analysis was conducted, including paired difference t-test, to examine intraoperative variables and clinical outcomes. The EVP technique employs the GreenLight XPS™ laser and the Moxy™ fiber. First, the prostate is enucleated by subcapsular dissection using low energy settings. Prostatic glandular tissue is then directionally vaporized to reduce energy transfer to the prostatic capsule and underlying nervous plexus. Results: Our first 10 patients who underwent Greenlight EVP were with an average age of 65 years (52–81 years) at the time of procedure and a mean prostate volume of 57 cc (35–70 cc). Total length of procedure averaged 72 minutes (50–100 minutes) with 61 minutes of laser time (45–85 minutes) and an average energy use of 339 kJ (150–550 kJ). At 1 year postprocedure, patients experienced improved urinary flow from preoperative Qmax of 7.3 to 17.6 mL/sec (p<0.00001), decreased postvoid residual volumes from 108 to 39 cc (p=0.005), and improved International Prostate Symptom Survey scores from 25.5 to 7.5 (p=0.00001). Conclusions: EVP is an effective treatment option for BPH with notable improvement in urinary flow and lower urinary tract symptoms over the early learning curve. It offers distinct promise in reducing complications such as capsular perforation or injury to the prostatic nervous plexus through energy transfer. Previous studies have also noted improvement for large-volume glands.4 The EVP technique merits further study to establish longer term safety and efficacy. No competing financial interests exist. Runtime of video: 6 mins 44 secs