GreenLight Photoselective Vaporization Of The Prostate Research Articles

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.

Trends of Benign Prostatic Hyperplasia Procedures in Ambulatory Surgery Settings.

Introduction: Holmium laser enucleation of the prostate (HoLEP) has evidenced-based advantages in treating benign prostatic hyperplasia (BPH) relative to other interventions. Unfortunately, the adoption of HoLEP has remained relatively low in Medicare and the National Surgical Quality Improvement Program populations. HoLEPs role as an inpatient surgical intervention is changing as advancements in the technique and systems have demonstrated the feasibility of same-day discharge. Thus, our objective was to evaluate national HoLEP trends in ambulatory surgery settings from 2016 to 2019. Materials and Methods: The Nationwide Ambulatory Surgery Sample (NASS) is the largest national all-payer database of ambulatory surgical encounters, managed by the Agency for Healthcare Research and Quality. A cross-sectional retrospective analysis of the 2016 and 2019 NASS was performed. Rates of BPH surgeries were calculated and stratified by age, census region, and primary payer to compare across time points for trends. Chi-squared tests and two-sample t-tests were completed for categorical and continuous variables, respectively. Results: The total number of ambulatory BPH surgeries fell 20% between 2016 (n = 124,538) and 2019 (n = 100,593). In 2016, HoLEP lagged behind photoselective vaporization of the prostate (PVP) and transurethral resection of prostate (TURP) with 4.7% of surgeries but rose to the second most common procedure in 2019 with 8.3% of total surgeries. TURP was the most common intervention (62.6% in 2016, 90.7% in 2019). Simple prostatectomy was the most expensive intervention. By U.S. census region, more HoLEPs were carried out in the South (43.1% in 2016, 37.5% in 2019) and Midwest (26.8% in 2016, 31.7% in 2019). Conclusions: Overall, HoLEP uptake is increasing. HoLEP has replaced greenlight PVP as the second most frequently used intervention. The rate of ambulatory HoLEPs has nearly doubled despite a general decrease in the number of surgeries.

MP51-06 SAFETY AND EFFICACY OF GREENLIGHT PVP IN OCTOGENARIANS: EVALUATION OF THE GLOBAL GREENLIGHT GROUP DATABASE

MP51-06 SAFETY AND EFFICACY OF GREENLIGHT PVP IN OCTOGENARIANS: EVALUATION OF THE GLOBAL GREENLIGHT GROUP DATABASE

MP13-10 PERIOPERATIVE AND FUNCTIONAL OUTCOMES OF GREENLIGHT 180-W PHOTOVAPORIZATION IN LARGE (&gt;80 CC) PROSTATES: AN ANALYSIS FROM 7 CENTERS IN THE INTERNATIONAL GLOBAL GREENLIGHT GROUP

You have accessJournal of UrologyCME1 Apr 2023MP13-10 PERIOPERATIVE AND FUNCTIONAL OUTCOMES OF GREENLIGHT 180-W PHOTOVAPORIZATION IN LARGE (>80 CC) PROSTATES: AN ANALYSIS FROM 7 CENTERS IN THE INTERNATIONAL GLOBAL GREENLIGHT GROUP Nicholas Corsi, David-Dan Nguyen, Adel Arezki, Iman Sadri, Kyle Law, David Bouhadana, Claudia Deyirmendjian, Naeem Bhojani, Dean S. Elterman, Franck Bruyère, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo F. Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, Bilal Chughtai, and Kevin C. Zorn Nicholas CorsiNicholas Corsi More articles by this author , David-Dan NguyenDavid-Dan Nguyen More articles by this author , Adel ArezkiAdel Arezki More articles by this author , Iman SadriIman Sadri More articles by this author , Kyle LawKyle Law More articles by this author , David BouhadanaDavid Bouhadana More articles by this author , Claudia DeyirmendjianClaudia Deyirmendjian More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Dean S. EltermanDean S. Elterman More articles by this author , Franck BruyèreFranck Bruyère More articles by this author , Luca CindoloLuca Cindolo More articles by this author , Giovanni FerrariGiovanni Ferrari More articles by this author , Carlos Vasquez-LastraCarlos Vasquez-Lastra More articles by this author , Tiago Borelli-BovoTiago Borelli-Bovo More articles by this author , Edgardo F. BecherEdgardo F. Becher More articles by this author , Hannes CashHannes Cash More articles by this author , Maximillian ReimannMaximillian Reimann More articles by this author , Enrique RijoEnrique Rijo More articles by this author , Vincent MisraiVincent Misrai More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , and Kevin C. ZornKevin C. Zorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. However, prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of Greenlight PVP in men with larger prostates (≥80 cc) from the largest international experience METHODS: Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011-2019 were eligible and assigned into two groups based on their prostate size (≥80 cc and <80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe. RESULTS: 3,426 men met the inclusion criteria. 34.6% (n=1,187) patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI: 18.46 – 19.88; Figure 1, p<0.01). There was also a significant drop in PVR at both 6- (p=0.007) and 12-months (p=0.005). There were no significant differences in transfusion (p=0.42), hematuria (p=0.80), or 30-day readmission rates (p=0.28). CONCLUSIONS: Our results from >3000 patients suggest Greenlight PVP-180 W is a safe and effective alternative for patients with prostate sizes ≥80 cc, with outcomes relatively independent from prostate size. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e177 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Corsi More articles by this author David-Dan Nguyen More articles by this author Adel Arezki More articles by this author Iman Sadri More articles by this author Kyle Law More articles by this author David Bouhadana More articles by this author Claudia Deyirmendjian More articles by this author Naeem Bhojani More articles by this author Dean S. Elterman More articles by this author Franck Bruyère More articles by this author Luca Cindolo More articles by this author Giovanni Ferrari More articles by this author Carlos Vasquez-Lastra More articles by this author Tiago Borelli-Bovo More articles by this author Edgardo F. Becher More articles by this author Hannes Cash More articles by this author Maximillian Reimann More articles by this author Enrique Rijo More articles by this author Vincent Misrai More articles by this author Bilal Chughtai More articles by this author Kevin C. Zorn More articles by this author Expand All Advertisement PDF downloadLoading ...

Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database.

The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians. The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80. Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Qmax) that favoured younger patients (10.3 vs 12.6ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6-18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01). GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.

Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database.

GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates.The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80cc) vs. small prostates (< 80cc). Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80cc). 11 functional and perioperative covariates were collected.Analyses were adjusted for patient age and presence of median lobe. 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups.The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80cc) prostate group at 12months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12months (p = 0.005).Therewere no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80cc, with durable outcomes relatively independent from prostate size.

MP01-18 GREENLIGHT PHOTOVAPORIZATION OF THE PROSTATE IN HIGH-MEDICAL-RISK PATIENTS: AN ANALYSIS OF THE GLOBAL GREENLIGHT GROUP (GGG) DATABASE

You have accessJournal of UrologyCME1 May 2022MP01-18 GREENLIGHT PHOTOVAPORIZATION OF THE PROSTATE IN HIGH-MEDICAL-RISK PATIENTS: AN ANALYSIS OF THE GLOBAL GREENLIGHT GROUP (GGG) DATABASE David-Dan Nguyen, Claudia Deyirmendjian, Kyle Law, Naeem Bhojani, Dean Elterman, Bilal Chughtai, Franck Bruyere, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, and Kevin Zorn David-Dan NguyenDavid-Dan Nguyen More articles by this author , Claudia DeyirmendjianClaudia Deyirmendjian More articles by this author , Kyle LawKyle Law More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Dean EltermanDean Elterman More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Franck BruyereFranck Bruyere More articles by this author , Luca CindoloLuca Cindolo More articles by this author , Giovanni FerrariGiovanni Ferrari More articles by this author , Carlos Vasquez-LastraCarlos Vasquez-Lastra More articles by this author , Tiago Borelli-BovoTiago Borelli-Bovo More articles by this author , Edgardo BecherEdgardo Becher More articles by this author , Hannes CashHannes Cash More articles by this author , Maximillian ReimannMaximillian Reimann More articles by this author , Enrique RijoEnrique Rijo More articles by this author , Vincent MisraiVincent Misrai More articles by this author , and Kevin ZornKevin Zorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous analyses of the safety and effectiveness of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients were limited by their small sample size and the ability to adjust for important confounders. We sought to characterize the adjusted outcomes of GreenLight PVP in HMR patients using data from the largest 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. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume. RESULTS: In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Pre-operatively, HMR patients had greater PVR and worse QoL. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p<0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4–2.8, p<0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+0.54 (95% CI 0.07–1.0, p=0.02)]. PVR also decreased 93.1ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6–152.6, p<0.01). PSA and Qmax change did not differ significantly between both study arms. CONCLUSIONS: We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients. Source of Funding: No funding or other financial support was received © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e8 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David-Dan Nguyen More articles by this author Claudia Deyirmendjian More articles by this author Kyle Law More articles by this author Naeem Bhojani More articles by this author Dean Elterman More articles by this author Bilal Chughtai More articles by this author Franck Bruyere More articles by this author Luca Cindolo More articles by this author Giovanni Ferrari More articles by this author Carlos Vasquez-Lastra More articles by this author Tiago Borelli-Bovo More articles by this author Edgardo Becher More articles by this author Hannes Cash More articles by this author Maximillian Reimann More articles by this author Enrique Rijo More articles by this author Vincent Misrai More articles by this author Kevin Zorn More articles by this author Expand All Advertisement PDF DownloadLoading ...

GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database.

We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database. 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. Eligible study participants underwent GreenLight PVP using the XPS-180W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume. In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1ml more in HMR than in non-HMR patients after 12months (95% CI 33.6-152.6, p < 0.01). We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.

Efficacy and Safety of the Sandwich Method in Patients with Benign Prostate Hyperplasia: Bipolar Transurethral Resection with GreenLight Vaporization.

Benign prostate hyperplasia (BPH) refers to the nonmalignant enlargement of the transition zone of the prostate gland. While holmium laser enucleation of the prostate and open simple prostatectomy are effective in the management of patients with large prostates, they have some limitations. Thus, this study aimed to analyze the efficacy and safety of the sandwich method of bipolar transurethral resection of the prostate (B-TURP) and GreenLight photoselective vaporization of the prostate (GLPVP) in patients with large prostates. Patients diagnosed with BPH who underwent the sandwich method with B-TURP and GLPVP from 2015 to 2020 were included. Efficacy analyses included the change in the uroflowmetry results in both group A (prostate volume < 80 g) and group B (prostate volume ≥ 80 g), and complication analyses included perioperative complications, early postoperative complications at three months and late postoperative complications at 12 months. The cohort comprised 188 and 44 patients in groups A and B, respectively. The prostate volume of groups A and B were 50.83 ± 14.14 g and 102.03 ± 19.36 g (p < 0.001), respectively. The peak (Qmax) and average (Qavg) flow rates were comparable between the two groups. The only significant difference noted was in the postoperative post-void residual (PVR) urine. Improvement was seen in all the variables including the Qmax, Qavg and PVR urine in each group. No patient experienced perioperative complications. Analysis of the overall one-year complication rate showed no significant difference between the two groups. The sandwich method of B-TURP and GLPVP may be feasible for the management of patients with large prostate.

Risk Factors of Emergency Room Visits for Bleeding Complications Following Transurethral Procedures in the Treatment of Benign Prostatic Hyperplasia: A Retrospective Cohort Study.

PurposeTransurethral procedures, including transurethral resection of the prostate (TURP) and laser prostatectomy, are often linked to emergency room (ER) visits for postoperative bleeding. Although some studies have been conducted, the risk factors associated with these ER visits are not completely understood. This retrospective cohort study identified potential risk factors associated with ER visits for postoperative bleeding.Patients and MethodsPreoperative assessment data and operational and postoperational parameters recorded at Chang Gung Memorial Hospital, Taiwan between December 2015 and January 2017 for patients who underwent elective transurethral procedures were analyzed to identify potential risk factors. The primary endpoint was ER visits for gross hematuria within three months following operation, and the secondary endpoint was ER visits for blood clot-induced urinary retention (clot retention) within three months following operation.ResultsA total of 665 patients who underwent elective transurethral procedures were enrolled. The transurethral procedures included monopolar transurethral resection of the prostate (M-TURP), bipolar TURP (B-TURP), greenlight photoselective vaporization of the prostate (PVP), thulium laser enucleation of the prostate (ThuLEP) and thulium laser transurethral vaporesection of the prostate (ThuVARP). Regarding ER visits for clot retention within three months, multivariable logistic regression revealed significantly lower rates of clot retention in patients who received B-TURP than in those who underwent ThuVARP (AOR, 0.18; 95% confidence interval [CI], 0.04–0.82, p = 0.027). Moreover, significantly higher clot retention was observed in patients who underwent two or more rounds of manual irrigation (AOR, 9.51; 95% CI, 1.66–54.43, p = 0.011).ConclusionMultiple manual irrigations shortly after operation can be considered a novel predictor of postoperative clot retention-related ER visits. Among the transurethral procedures, ThuVARP was associated with a higher risk of clot retention-related ER visits than was B-TURP.

Influence of the median lobe on the results at 4 years of the prostate vaporization by GreenLight laser.

The aim of this study was to examine the influence of a median lobe (ML) on complications and functional results after 4 years of GreenLight photoselective vaporization of the prostate (PVP). All men undergoing GreenLight PVP for benign prostatic hyperplasia were included in the baseline analysis and followed prospectively. Two groups were formed according to the presence or absence of the prostatic ML. Complications classified according Clavien and Dindo and functional results (International Prostate Symptom Score [IPSS], quality of life, maximum urinary flow rate [Qmax], and postvoid residual [PVR]) were evaluated with 4 years of follow-up. The pre- and postoperative data were compared by a chi-square test (χ2 ) for the qualitative variables and by a Student t test for the quantitative variables. A total of 432 patients (172 with ML and 260 without ML) were included prospectively from September 2005 to October 2013. The initial populations were comparable. At 4 years of follow-up, the improvement in mean IPSS was significantly greater for patients with ML at 6, 12, 24, and 48 months. The improvement in Qmax was significantly greater for patients with ML at 1, 6, 24, and 48 months. There was no significant difference between the two groups concerning the PVR reduction, the occurrence of complications, the level of average prostate-specific antigen, and the average ultrasound volume at 4 years. There is a clearer and longer-lasting improvement in urinary symptoms in patients with prostatic ML. The indication of PVP in those patients seems to be excellent, with good results persisting at 4 years.

Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety.

Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. Data from 3627 patients who underwent GL-PVP with the XPS-180W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. At baseline, median age, prostate volume, PSA, and IPSS were 70years (interquartile range 64-77), 64 (47-90), 3.1ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62min (46-85), respectively. Median energy use was 250.0kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2days. All-cause mortality within 30days was 0.3%. Median PSA reduction at 3months and 60months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.

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.

Previous analyses ofthe 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 180W XPS GreenLight PVP using a large international database. Data were obtained from the Global GreenLight Group (GGG) database whichpools 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-180W 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. 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 6months which was 46.51ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes. 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-180W system.

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.

Reasons to go for Rezūm steam therapy: an effective and durable outpatient minimally invasive procedure.

In this review, we will discuss the state of the literature regarding Rezūm and opportunities for its application in the treatment of BPH. A comprehensive review of original research on convective water vapor thermal therapy (Rezūm) was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, Aquablation, and greenlight photoselective vaporization of the prostate were reviewed for discussion. Rezūm distinguishes itself from other treatment options by its durable improvement in objective clinical outcomes such as IPSS and BPH Impact Index, while being cost-effective and versatile in its ability to treat a variety of prostate gland morphologies. This treatment option shows good lower urinary tract symptom relief, especially in small-to-moderate prostate sizes (30-80cc). The use of convective heat transfer is unique and allows for localized treatment, avoiding damage to surrounding structures, thus providing an excellent safety profile and sexual function preservation. The current evidence on Rezūm warrants its consideration as a therapeutic alternative to transurethral surgery in selected patients.

Reasons to overthrow TURP: bring on Aquablation.

In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign prostatic enlargement (BPE). A comprehensive review of original research on Aquablation was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, greenlight photoselective vaporization of the prostate, and simple prostatectomy were reviewed for discussion. For small-medium prostates (30-80mL), Aquablation's main advantages include better ejaculatory function and similar functional outcomes compared to TURP. For large prostates (80-150mL), Aquablation demonstrates shorter operative time and superior ejaculatory function when compared to simple prostatectomy, HoLEP, and Greenlight PVP. In addition, Aquablation displays shorter hospital stays than simple prostatectomy. The integration of software programming and semi-automatic technology increases the reproducibility of the procedure and helps standardize overall outcomes, while also accelerating the learning curve. Its ability to preserve antegrade ejaculation makes Aquablation a very compelling option for sexually active patients. However cost and postoperative bleeding risks remain a concern. The current evidence suggests that Aquablation is a safe and effective alternative for BPE for small to large prostates. Further prospective clinical trials, with comparisons to other BPE modalities, and data from longer follow-up periods are still required.

PD61-07 GLOBAL GREENLIGHT GROUP: LARGEST INTERNATIONAL GREENLIGHT EXPERIENCE FOR BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (PD61)1 Apr 2020PD61-07 GLOBAL GREENLIGHT GROUP: LARGEST INTERNATIONAL GREENLIGHT EXPERIENCE FOR BENIGN PROSTATIC HYPERPLASIA Kyle Law, Côme Tholomier, Félix Couture, Ahmed Zakaria, David-Dan Nguyen, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo Becher, Hannes Cash, Maximilian Reimann, Vincent Misrai, and Kevin Zorn* Kyle LawKyle Law More articles by this author , Côme TholomierCôme Tholomier More articles by this author , Félix CoutureFélix Couture More articles by this author , Ahmed ZakariaAhmed Zakaria More articles by this author , David-Dan NguyenDavid-Dan Nguyen More articles by this author , Luca CindoloLuca Cindolo More articles by this author , Giovanni FerrariGiovanni Ferrari More articles by this author , Carlos Vasquez-LastraCarlos Vasquez-Lastra More articles by this author , Tiago Borelli-BovoTiago Borelli-Bovo More articles by this author , Edgardo BecherEdgardo Becher More articles by this author , Hannes CashHannes Cash More articles by this author , Maximilian ReimannMaximilian Reimann More articles by this author , Vincent MisraiVincent Misrai More articles by this author , and Kevin Zorn*Kevin Zorn* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000978.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Amongst the surgical treatment modalities available, Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of BPH, with hemostatic benefits particularly in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling intra- and postoperative outcomes from multiple academic centres globally. METHODS: Data from 2143 patients who underwent Greenlight 180W-XPS PVP in 5 international centres by 6 expert surgeons between 2010 and 2019, was retrospectively analyzed. Demographic, peri- and postoperative data was collected, including IPSS, QOL, Qmax, PVR, and PSA. Clavien-Dindo postoperative adverse events were also assessed. RESULTS: Median age, prostate volume, PSA and IPSS was 68 years (IQR 63-75), 64cc (49-88), 3.1 ng/mL (1.7-5.0) and 23 (20-28), respectively. Median lasing time was 30 min (21-41) during a median 60 min (45-80) procedure. Median energy use was 244 kJ (166-355), with 92.5% of procedures being completed with 1 laser fiber. In 63% of cases, Foley catheter was removed on postoperative day 1 with 84.8% of men being discharged within 2 days of admission. The 30-day postoperative readmission rate was 3.9%, while major cardiac events and death occurred in 0.8% and 0.3% of cases respectively. Prostatic adenocarcinoma was found on tissue pathology in 2.3% of cases. Median PSA reduction at 12 months, 24 months and 60 months was 46.3%, 59.7% and 51.4% respectively. CONCLUSIONS: To the best of our knowledge, from the largest multi-user, international experience, GreenLight PVP of the prostate is a safe, effective and durable BPH procedure. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1282-e1282 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Law More articles by this author Côme Tholomier More articles by this author Félix Couture More articles by this author Ahmed Zakaria More articles by this author David-Dan Nguyen More articles by this author Luca Cindolo More articles by this author Giovanni Ferrari More articles by this author Carlos Vasquez-Lastra More articles by this author Tiago Borelli-Bovo More articles by this author Edgardo Becher More articles by this author Hannes Cash More articles by this author Maximilian Reimann More articles by this author Vincent Misrai More articles by this author Kevin Zorn* More articles by this author Expand All Advertisement PDF downloadLoading ...

GreenLight Photoselective Vaporization of the Prostate: One Laser for Different Prostate Sizes.

Introduction: GreenLight laser vaporization of the prostate (photoselective vaporization of the prostate [PVP]) is a safe and effective procedure for Benign Prostatic Hyperplasia. Long-term results and advantages of PVP in patients with large and symptomatic prostate are still under evaluation. Materials and Methods: In a multicenter experience, patients who underwent standard or anatomical PVP were retrospectively reviewed. Patients with follow-up >12 months were divided into two groups based on prostate volume (<100 cc vs ≥100 cc). Pre- and perioperative data, as well as postoperative results and complications, were recorded after 3, 6, and 12 months and then annually. Results: One thousand and thirty-one patients were eligible, 916 of these had a prostate volume of <100 cc and 115 ≥ 100 cc. Median follow-up period was 25.0 months (interquartile range [IQR] 16.5-35.0) and 16.0 months (IQR 12.0-24.0) in ≥100 and <100 groups, respectively. No difference was found in terms of catheterization time, postoperative stay, and postoperative acute urine retention. Patients with prostate ≥100 required longer operative time (75 vs 55 minutes), lasing time (41.7 vs 24.9 minutes), and higher energy used but lower energy density. Patients with prostate ≥100 had a higher incidence of early (50.4% vs 35.7%) and late complications (21.7% vs 12.8%) and early urge/incontinence symptoms (40.9% vs 29.3%). No statistically significant differences were found for the maximum urinary flow (Qmax) and International Prostate Symptom Score (IPSS) results between the two groups. The reintervention rate in ≥100 group was 3.5% vs 2.3% in <100. Conclusions: In the midterm follow-up, GreenLight PVP guarantees the same results in different prostate volume groups. Early and late complications are more frequent in large prostates.

Vaporization of Prostate by 160W GreenLight Laser on Postoperative Erectile Function

ObjectiveTo evaluate the impact of photoselective vaporization of the prostate (PVP) on erectile function (EF) utilizing a 160W GreenLight laser system with up to 36 months of follow-up in men with lower urinary tract symptoms caused by benign prostatic hyperplasia. MethodsA prospectively maintained database of patients who underwent GreenLight PVP was retrospectively reviewed. International Index of Erectile Function-5 (IIEF-5) questionnaire was used to assess EF. In total, 265 sexually active patients who underwent 160W GreenLight laser PVP were identified and divided into Group A with baseline IIEF-5 <19 and group B with baseline IIEF-5 ≥19. IIEF-5, International Prostate Symptom Score, quality of life, postvoid residual, and Qmax were recorded preoperatively, perioperatively, and at follow-up after 1, 3, 6, 12, 24, and 36 months. Recorded data were analyzed statistically using t- and χ2 tests. ResultsThe preoperative and perioperative data of the 2 groups were comparable. Significant improvements in International Prostate Symptom Score, Qmax, quality of life, and postvoid residual were observed in both groups at every follow-up visit throughout the 36 months with no significant difference between the groups. EF was sustained postoperatively compared with the baseline in the whole study population. In Group A (preoperative IIEF-5 <19), EF was significantly improved at 1 month and 12 month (P= .02 and P= .002). ConclusionIn patients undergoing PVP by 160W GreenLight laser for lower urinary tract symptoms secondary to benign prostatic hyperplasia, no significant detrimental effect was observed in the EF at up to 3 years of follow-up. However, in patients with preoperative erectile dysfunction (ED), we showed a significant improvement.

Stopping or maintaining oral anticoagulation in patients undergoing photoselective vaporization of the prostate (SOAP) surgery for benign prostate obstruction: study protocol for a multicentre randomized controlled trial

BackgroundLower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. The GreenLight PVP is usually considered as an interesting surgical option for patients treated via oral anticoagulants (OACs) with regard to its haemostatic properties. The aim of this study was to assess the impact of maintaining OAC treatment in patients undergoing PVP.MethodsThis study is a multicentre, open-label, randomized controlled trial (RCT) designed to show the non-inferiority of PVP surgery in patients with BPO treated with OACs. This study is designed to enrol 386 OAC-treated patients (treated with vitamin K antagonists and direct oral anticoagulants) who are undergoing PVP for BPO. Patients will be randomized (1:1) to either maintain or stop OAC treatment during the perioperative course. The intervention group will maintain OAC treatment until the day before surgery and resume OAC treatment the day after surgery, whereas the control group will stop OAC treatment (with or without low-molecular-weight heparin bridging therapy) according to the anaesthesia guidelines. The primary outcome of interest to be assessed is the 30-day complications rate according to the Clavien-Dindo classification. The secondary endpoint will examine the 30-day rate of haemorrhagic and thrombotic events. This study will provide 80% power to show non-inferiority, defined as not worse than a 10% (non-inferiority margin) inferior change in the proportion of patients with good outcomes (Clavien-Dindo score < 2), using two-tailed 95% confidence intervals.DiscussionThis first multicentre RCT in the field is underway to evaluate the safety and efficacy of PVP in patients with ongoing OAC therapy. The study results could influence the perioperative management of OACs in BPO surgery with a high level of evidence.Trial registrationClinicalTrials.gov, NCT03297281. Registered on 29 September 2017.