GreenLight Laser Photoselective Vaporization Research Articles

Successful Treatment of Bladder Outlet Obstruction With GreenLight Laser Photoselective Vaporization of Prostate Operation for a High-Risk Patient With a Very Large Prostate Volume

Successful Treatment of Bladder Outlet Obstruction With GreenLight Laser Photoselective Vaporization of Prostate Operation for a High-Risk Patient With a Very Large Prostate Volume

Therapeutic efficacy of 180-W GreenLight laser photoselective vaporization of the prostate for storage symptoms concomitant with benign prostatic obstruction and a search for outcome predictors.

Benign prostatic obstruction (BPO) is the most common cause of lower urinary tract symptoms among men. GreenLight photoselective vaporization of the prostate (GL-PVP) using a 180-W Xcelerated performance system (XPS) laser is a well-established method for treating BPO-induced voiding symptoms. However, its therapeutic effects on storage symptoms remain unclear. This study aimed to analyze the storage outcomes in patients who underwent 180-W XPS GL-PVP for BPO and to identify outcome predictors. Patients who underwent 180-W XPS GL-PVP for BPO between May 2018 and May 2021 were retrospectively reviewed. Data on clinical characteristics, prostate volume, preoperative and postoperative International Prostate Symptom Scores (IPSS), and preoperative urodynamic parameters were collected. A favorable storage outcome was defined as ≥50% reduction in the IPSS storage subscore. Ninety-nine male patients were included, with a mean age of 69.4 ± 9.6 years and a baseline prostatic volume of 75.9 ± 33.1 mL. The IPSS total, storage, and voiding subscores significantly decreased after GL-PVP (all p < 0.001). Seventy-two patients achieved favorable storage outcome at 6 months. Multivariate analysis revealed that detrusor underactivity was predictive of unfavorable storage outcomes (p = 0.022), while IPSS voiding-to-storage subscore ratio >1.25 and the presence of detrusor overactivity were predictive of favorable storage outcomes (p = 0.008 and 0.033, respectively). 180-W XPS GL-PVP provided excellent outcomes in both voiding and storage lower urinary tract symptoms concomitant with BPO. Preoperative IPSS and multichannel urodynamic parameters including detrusor overactivity and underactivity are valuable predictors of postoperative storage outcomes.

Effect of saline perfusion before catheter removal in patients with BPH treated with GreenLight laser photoselective vaporization of the prostate.

To investigate the effect of saline perfusion before catheter removal in patients with benign prostatic hyperplasia (BPH) treated with GreenLight laser photoselective vaporization of the prostate (PVP). Patients (n=200) with BPH treated with PVP were divided into perfusion (n=100) and control (n=100) groups. For the perfusion group, saline (200 mL or the maximum capacity tolerated) was irrigated into the bladder after standardized external urethral disinfection, and the catheter was removed. Catheter removal was routinely performed in the control group. Perioperative adverse events and clinical outcomes were compared between the groups. Patients in the perfusion group had a shorter waiting time [3 (0-4) vs. 15 (8.75-26) min; P<0.001] and a better satisfaction grade [24 (21.75-26) vs. 23 (20-25); P=0.016] for first urination than those in the control group. The perfusion group exhibited lower anxiety levels regarding first urination than the control group [1 (1-2) vs. 1.5 (1-2), respectively; P=0.012]. Urinalysis revealed that the perfusion group had significantly lower white blood cell (WBC) count than the control group on the day [25.5 (8-37.75) vs. 43.5 (24.0-64.75); P<0.001] and 2 weeks [20.5 (11-27) vs. 31.0 (20-42); P<0.001] after catheter removal. No significant differences in treatment-related adverse events were observed [perfusion (n=15), control (n=20)]. Saline perfusion before catheter removal in patients with BPH treated with PVP could shorten the waiting time for first urination, improve patient anxiety and satisfaction and reduce postoperative urinary WBC levels.

Greenlight laser (XPS-180watt) prostatectomy for treatment of benign prostate obstruction, Pursuit of durability

ABSTRACT Objectives To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPSTM system are still pending. Patients and methods Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported. Results Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, P = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (P = 0.03). In retreatment group, more intraoperative bleeding (P = 0.02), early postoperative hematuria (P = 0.03), higher median preoperative PSA (P = 0.02) and less postoperative one-year percent PSA reduction (P = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52–0.76). Median (range in months) time to event was 20 (1–60) for all cases and 13.5 (1–42) and 30 (18–60), P = 0.7, for GL.PVP and GL.PVEP groups, respectively. Conclusion Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.

SC71 - Efficacy and safety profile of greenlight laser photoselective vaporization of the prostate in fragile and elderly patients: results from the italian greenlight laser study group

SC71 - Efficacy and safety profile of greenlight laser photoselective vaporization of the prostate in fragile and elderly patients: results from the italian greenlight laser study group

180-W GreenLight laser photoselective vaporization with multiple triamcinolone acetonide injections for the treatment of bladder neck contractures.

Bladder neck contracture (BNC), one of the most challenging complications after transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP), lacks effective treatment. In the present study, our experience in treating BNC using GreenLight laser vaporization with triamcinolone acetonide (TA) injections was shared. This is a retrospective cohort study that included 46 patients with BNC after TURP and PVP in our center. GreenLight laser surgeries (180W) were carried out and TA was administrated simultaneously. TA injections were repeated every week for three times after surgeries. The perioperative and postoperative parameters were reviewed and compared. Bladder neck tissues were examined by immunohistochemical staining to explore the expressions of collagen I, matrix metalloproteinase-3 (MMP-3), and transforming growth factor-β (TGF-β) after treatments. The chief complaint symptoms of all patients were significantly relieved after our treatments. None of them showed BNC recurrence during the follow-up. Complications were rare and mild. Postoperative assessments including maximal urinary flow rate (P < 0.01), International Prostate Symptom Score (P < 0.01), quality of life index (P < 0.01), and post-void residual volume (P < 0.001) were significantly better than baseline values, respectively. Immunohistochemical staining showed significantly lower expressions of collagen I (P < 0.001), MMP-3 (P < 0.001), and TGF-β (P < 0.001) after treatments. In conclusion, 180-W GreenLight laser with repeated TA injections demonstrated the safety and long-term efficacy in treating BNC, by inhibiting the expressions of fibrotic factors. Our procedure was a promising treatment for BNC after PVP and TURP.

Outpatient 180 W XPS GreenLight Laser Photoselective Vaporization of the Prostate: 7-Year Experience.

Purpose: GreenLight XPS Laser System (GL-XPS) photoselective vaporization of the prostate (PVP) is not only noninferior to transurethral resection of the prostate, but also with shorter rates of hospital stay and length of catheterization. Scarce literature has been published about the feasibility and safety of performing GL-XPS PVP in an outpatient setting. Our aim is to report our 7-year experience with outpatient GL-XPS PVP. Methods: Medical charts of all patients who underwent GL-XPS PVP between 2013 and 2020 were reviewed. Patients were discharged after careful monitoring in the recovery room and the catheter was removed either at home or at a scheduled hospital visit. We used the Shapiro-Wilk test to assess for normal distribution, and the evaluation of homoscedasticity was performed with the SD test. For qualitative variables, the comparison between groups was carried using the chi-square test and for the quantitative variables we used the nonparametric Mann-Whitney U test. Results: A total of 537 patients were treated, 517 in an outpatient basis. Median age was 68 years (interquartile range [IQR] 62-76), median prostate volume 50 cc (IQR 40-70). 22.8% were on anticoagulants or antiplatelet therapy. Median operative time was 100 minutes (IQR 75-125), length of hospital stay 5 hours (IQR 4-6.45), mean length of catheterization 48 hours (SD 14.92). Readmission rate within 90 days of surgery was 11.7%, 58 (10.8%) for surgical-related complications. Median time for readmission was 4 days (IQR 2-24). Immediate readmission (within 10 days) was recorded in 7.6% of patients, urinary retention was the main cause. No significant differences were found trying to find perioperative predictors for readmission. Conclusions: Our experience suggests that outpatient GL-XPS PVP could be performed safely with a predefined outpatient pathway, with a low readmission and complication rate. (IRB number CEI-521).

MP01-13 GREENLIGHT (532 nm) LASER TRANSURETHRAL PROSTATECTOMY FOR TREATMENT OF BENIGN PROSTATE OBSTRUCTION USING XPS-180 WATT SYSTEM, DOES IT PASS THE TEST OF TIME?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-13 GREENLIGHT (532 nm) LASER TRANSURETHRAL PROSTATECTOMY FOR TREATMENT OF BENIGN PROSTATE OBSTRUCTION USING XPS-180 WATT SYSTEM, DOES IT PASS THE TEST OF TIME? Fady Ghobrial, Mahmoud Laymon, Mohamed Soltan, Ahmed Abolazm, Nasr El-Tabey, and Ahmed Elshal Fady GhobrialFady Ghobrial More articles by this author , Mahmoud LaymonMahmoud Laymon More articles by this author , Mohamed SoltanMohamed Soltan More articles by this author , Ahmed AbolazmAhmed Abolazm More articles by this author , Nasr El-TabeyNasr El-Tabey More articles by this author , and Ahmed ElshalAhmed Elshal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate efficacy and durability of greenlight laser (XPS-180watt) based prostatectomy for treatment of benign prostatic obstruction (BPO). The need for medical and or surgical retreatment for recurring or residual BPO as well as their predictors will be assessed. METHODS: After IRB approval, a prospectively maintained database was established for patients with BPO for whom greenlight laser photoselective vaporization (PVP) and vapoenucleation (PVEP) of the prostate were carried out between August 2014 to March 2018. Patients’ perioperative data and urinary functional outcome parameters and postoperative complications were depicted. The need for retreatment was assessed and its predictors retreatment were evaluated. RESULTS: This study included 248 patients, 157 (63.3%) and 91(36.7%) patients underwent PVP and PVEP with mean prostate volume (60±18 and 100±22 ml) respectively. Mean ±SD follow up duration was 62±9 months. At last point follow up, mean ±SD percentage of improvement in IPSS was 61±28 and 78±20 p=0.03, median (range) percentage of improvement in Q max was 119(-13-549) and 123(-13-649) % p=0.2 and median (range) percentage of PSA reduction was 63(-172-99) and 65(-75-97) % p=0.7 for PVP and PVEP groups respectively. Overall retreatment rate (medical and surgical) was 23% (57 patients), 38 (24.2%) after PVP and 19 (20.9%) after PVEP, p=0.5. The need surgical retreatment was statistically significant more after PVP (table 1). Median (range) time to event (defined as medical or surgical re-intervention) was 20 (1-60) for all cases, 3.5 (0-42) and 30 (18-60) months p= 0.7 for PVP and PVEP groups respectively. On multivariate analysis, only percent reduction of one-year post-operative PSA was a significant predictor of need for retreatment (surgical/ medical) of recurring or residual BPO (P 0.021, 95% CI 0.018-0.024). The cutoff point was 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76) above it there is less probability for having BPO retreatment. CONCLUSIONS: Greenlight laser prostatectomy using XPS-180Watt is an effective and versatile tool in treating BPO. Durability of the outcome is predictable with more postoperative PSA reduction. Source of Funding: No funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e5-e6 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fady Ghobrial More articles by this author Mahmoud Laymon More articles by this author Mohamed Soltan More articles by this author Ahmed Abolazm More articles by this author Nasr El-Tabey More articles by this author Ahmed Elshal More articles by this author Expand All Advertisement Loading ...

Review of the application of photoselective vaporization in benign hyperplasia of the prostate

Benign prostatic hyperplasia is the most frequent benign tumor in men, reaching a prevalence of 40% in the fourth decade of life and 80% in men 80 years of age and older. The condition leads to bothersome and incapacitating lower urinary tract symptoms that are currently measured by the International Prostate Symptom Score. At present, there are different alternatives for minimally invasive surgical treatment, such as GreenLight laser photoselective vaporization, that can provide the same benefits for the patient as conventional treatment options.&#x0D; Methods: To find out and describe the usefulness and safety of photoselective vaporization in patients with benign prostatic hyperplasia, a search for information published within the last 10 years was conducted on the PubMed, ScienceDirect, BVS, and ClinicalKey databases, resulting in the selection of 11 notable studies. &#x0D; Conclusion: GreenLight laser photoselective vaporization is a safe and efficacious alternative for managing the symptoms of benign prostatic hyperplasia, in the short term and long term, with a lower risk of complications than transurethral resection of the prostate.

Revisión de la aplicación de la vaporización fotoselectiva en hiperplasia benigna de próstata

Benign prostatic hyperplasia is the most frequent benign tumor in men, reaching a prevalence of 40% in the fourth decade of life and 80% in men 80 years of age and older. The condition leads to bothersome and incapacitating lower urinary tract symptoms that are currently measured by the International Prostate Symptom Score. At present, there are different alternatives for minimally invasive surgical treatment, such as GreenLight laser photoselective vaporization, that can provide the same benefits for the patient as conventional treatment options. Methods: To find out and describe the usefulness and safety of photoselective vaporization in patients with benign prostatic hyperplasia, a search for information published within the last 10 years was conducted on the PubMed, ScienceDirect, BVS, and ClinicalKey databases, resulting in the selection of 11 notable studies. Conclusion: GreenLight laser photoselective vaporization is a safe and efficacious alternative for managing the symptoms of benign prostatic hyperplasia, in the short term and long term, with a lower risk of complications than transurethral resection of the prostate.

P0085 - Long-term functional outcomes in large prostates (>80cc): A comparative study between Greenlight laser photoselective vaporization and open simple prostatectomy

P0085 - Long-term functional outcomes in large prostates (>80cc): A comparative study between Greenlight laser photoselective vaporization and open simple prostatectomy

Predictors of re-intervention after greenlight laser photoselective vaporization of the prostate: multicenter long/mid-term follow-up experience

Aim: Greenlight photoselective vaporization of the prostate (PVP) is considered a safe alternative to transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms (LUTS) and a prostate volume of 30-80 mL for the comparable short- and mid-term results. Long-term re-treatment rate is still being debated.

Editorial Comment on: "Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate" by Pierce et al.

Editorial Comment on: "Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate" by Pierce et al.

Editorial Comment on: “Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate” by Pierce et al.

<i>Editorial Comment on:</i> “Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate” by Pierce et al.

SC118 - Haemorrhagic complications after Greenlight laser photo-selective vaporization of the prostate: results from a monocentric cohort of high-risk patients

SC118 - Haemorrhagic complications after Greenlight laser photo-selective vaporization of the prostate: results from a monocentric cohort of high-risk patients

SC124 - Predicting factors of post-operative acute urinary retention after Greenlight laser photoselective vaporization of the prostate

SC124 - Predicting factors of post-operative acute urinary retention after Greenlight laser photoselective vaporization of the prostate

Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate.

Introduction: Obesity can lead to increased risk of perioperative complications in surgical patients, but evidence is lacking regarding the impact of obesity on bladder outlet surgery outcomes. We sought to assess the safety and efficacy of GreenLight photoselective vaporization of the prostate (PVP) in obese patients by comparing functional outcomes and complications in men, stratified according to the body mass index (BMI). Materials and Methods: A retrospective analysis was undertaken of 424 men who underwent 180W GreenLight PVP between 2012 and 2016 at two tertiary medical centers. Patients were stratified based on the World Health Organization (WHO) classification of obesity as determined by BMI. Normal weight men had BMI <25 kg/m2, overweight men had BMI between 25 and 30 kg/m2, and obese men had BMI greater than 30 kg/m2. Primary endpoints examined were differences in intraoperative outcomes and incidence of intraoperative and postoperative complications between BMI groups. Secondary endpoints were improvements in the International Prostate Symptom Score, quality of life score, and the uroflowmetry variables, maximum urinary flow rate and postvoid residual. Results: The BMI groups did not differ regarding operative time or lasing time after matching for prostate volume, but overweight patients in the matched cohort still required higher mean energy use than normal weight men (258.6 kJ vs 233.9 kJ; p = 0.017). No significant differences between BMI groups were observed for intraoperative complications, postoperative complications, or readmission rates. All functional parameters were significantly improved at 24 months for each group, with no differences in improvement between groups. On multivariable analysis, BMI was not a significant predictor for outcomes following PVP. Conclusions: Increased BMI has a negligible effect on intraoperative parameters and does not affect postoperative complication rates or functional outcomes. GreenLight XPS 180W PVP is a safe and effective procedure in overweight and obese men.

PD09-07 RETURNING THE ER: AN ANALYSIS OF EMERGENCY VISITS FOLLOWING UROLOGIC OUTPATIENT PROCEDURES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II (PD09)1 Apr 2020PD09-07 RETURNING THE ER: AN ANALYSIS OF EMERGENCY VISITS FOLLOWING UROLOGIC OUTPATIENT PROCEDURES Luke Witherspoon*, Rodney Breau, Christopher Knee, Ranjeeta Mallick, J. Stuart Oake, and Luke Lavallee Luke Witherspoon*Luke Witherspoon* More articles by this author , Rodney BreauRodney Breau More articles by this author , Christopher KneeChristopher Knee More articles by this author , Ranjeeta MallickRanjeeta Mallick More articles by this author , J. Stuart OakeJ. Stuart Oake More articles by this author , and Luke LavalleeLuke Lavallee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000836.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologic surgeries have been previously identified as having high rates of readmission compared to other surgeries. This study aims to identify risk factors leading to presentation to the emergency department (ED) following urologic outpatient surgery. METHODS: We examined all outpatient surgeries performed by urology, general surgery, thoracic surgery, and gynecology occurring at three hospitals within The Ottawa Hospital system between April 1, 2008, and February 28, 2018. We captured all ED visits within 90 days of the outpatient procedure. Surgical characteristics included hospital campus, procedure end time, and day/month/year of procedure. Patient characteristics assessed included age, sex, marital status, presence of primary care provider, socioeconomic status (SES), American Society of Anesthesiologists (ASA) score, and Elixhauser comorbidity index. RESULTS: 38,377 outpatient procedures were performed by the four services assessed over our time period. 5641 ED visits within 90 days were identified. Urological procedures accounted for 47.5% (n=2681) of the patients returning to the ED, representing a 16.2% rate of return to the emergency room following urologic day surgery. Furthermore, urologic patients were more likely to have several visits to the emergency room within 90 days compared to other surgical services (p<0.05). Univariable analyses of individual variables found that increased age, low SES, unmarried status were all associated with higher rates of ED visits (p<0.05). The median ER visit day post-procedure ranged from 5-17 depending on procedure type. Of the noted reasons for emergency presentation, the top 5 causes were directly related to urology with retention (11% of visits), and hematuria (10% of visits) being the most common. Of urological day surgery procedures ureteroscopy (Relative Risk (RR) 3.69, 95% CI 2.17,6.29), Greenlight Laser Photoselective Vaporization of the prostate (RR 3.6, 95% CI 2.05, 6.34), and ureteric stent insertion (RR 3.83, 95% CI 2.17, 6.76) had the highest rates of return to emergency in 90 days on multivariate analysis. CONCLUSIONS: ED visits following urologic outpatient procedures are common. This study identifies risk factors to identify patients that may benefit from additional education or support after outpatient urologic surgery to reduce ED care needs. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e177-e177 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke Witherspoon* More articles by this author Rodney Breau More articles by this author Christopher Knee More articles by this author Ranjeeta Mallick More articles by this author J. Stuart Oake More articles by this author Luke Lavallee More articles by this author Expand All Advertisement PDF downloadLoading ...

SC21 - Is Greenlight laser photoselective vaporization of the prostate a safe technique? Results from a wide monocentric series complications analysis, with a focus on postoperative fever and sepsis

SC21 - Is Greenlight laser photoselective vaporization of the prostate a safe technique? Results from a wide monocentric series complications analysis, with a focus on postoperative fever and sepsis

Comparison Between Thulium Laser VapoEnucleation and GreenLight Laser Photoselective Vaporization of the Prostate in Real-Life Setting: Propensity Score Analysis

To compare in daily practice efficacy and safety of standard 180-Watt GreenLight laser photoselective vaporization (PVP) and Thulium laser Vaporesection of the prostate (ThuVEP). All men were evaluated with prostate volume, prostate-specific antigen, International Prostate Symptom Score, and maximum urinary flow. Patient global impression of improvement was evaluated with patient global impression of improvement scale for 6 months. Antiplatelet/anticoagulant therapy, operation time, 24-hour hemoglobin drop , length of catheterization, discharge day, early complications, and reoperation after 30 days were gathered. Differences between interventions were estimated using propensity scores to adjust for different patients characteristics. The propensity scores were estimated by fitting a stepwise logistic regression model with intervention type as the dependent variable and all the covariates. Five hundred five men underwent the surgical procedures (291 PVP and 214 ThuVEP). Mean age was 69.6 years. Mean prostate volume was 54 mL. Median operation time was 55 minutes. Median catheterization time was 2 days in both series. After matching, the postoperative stay was similar in both groups (2 days). Hemoglobin drop for 24 hours was statistically significantly lower in PVP (-0.5 vs -0.8 g/dL, P .002). Most of the complications were mild-to-moderate and comparable among groups. Δ Maximum urinary flow was similar 6-month after surgery before and after matching, whereas PVP group had a better improvement 12-month after surgery. 96.4% of all patients had an improvement of their symptoms, with no difference between groups, before and after matching. Our study demonstrated that PVP and ThuVEP are similar in term of complications and outcomes, with high patients' satisfaction.