Advertisement

World Journal of Urology

, Volume 36, Issue 5, pp 793–799 | Cite as

Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience

  • Vincent MisraïEmail author
  • Marie Pasquie
  • Benoit Bordier
  • Benjamin Elman
  • Jean Michel Lhez
  • Julien Guillotreau
  • Kevin Zorn
Original Article

Abstract

Purpose

This study sought to compare perioperative outcomes and morbidities for open simple prostatectomy (OSP) and endoscopic green laser enucleation of the prostate (GreenLEP).

Methods

In a single department, all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and all consecutive patients undergoing GreenLEP between July 2013 and January 2017 were prospectively enrolled. Perioperative data, information regarding early postoperative complications for up to 6 months and outcomes were collected and retrospectively compared.

Results

Overall, 204 patients were enrolled in each group. The baseline characteristics of patients in both groups were comparable. Intraoperative time was significantly longer for the OSP group than for the GreenLEP group (67 versus 60 min; p < 0.0001). The OSP group had significantly longer catheterisation (5 versus 2 days; p < 0.0001) and hospitalisation times (7 versus 2 days; p < 0.0001) than the GreenLEP group. The overall rate of complications was significantly higher after OSP than after GreenLEP (37.2 versus 20.6%; p = 0.0003); both Clavien–Dindo grade 3a complications (8.8 versus 0.98%) and Clavien–Dindo grade 3b complications (2.4 versus 3.4%) were observed. The transfusion rate was higher after OSP than after GreenLEP (8.3 versus 0.5%; p = 0.0001). The rehospitalisation rate was similar for both groups (7.8 versus 8.3%; p = 0.99).

Conclusions

The results of this single-centre cohort study confirm those of similar prior investigations addressing endoscopic enucleation of the prostate. Compared with OSP, GreenLEP may have a more desirable perioperative profile with lower morbidity. In contrast, GreenLEP and OSP were associated with similar 6-month rehospitalisation rates.

Keywords

GreenLight Laser Prostate Enucleation Benign prostatic obstruction Surgical technique 

Notes

Author contributions

Protocol/project development: Misrai, Zorn. Data collection or management: Pasquie, Misrai. Data analysis: Pasquie. Manuscript writing/editing: Misrai, Guillotreau, Bordier, Lhez, Elman

Funding

None.

Compliance with ethical standards

Conflict of interest

Vincent Misrai is a consultant and proctor for Boston Scientific. Kevin Zorn is a consultant and proctor for Boston Scientific. Benoit Bordier, Benjamin Elman, Jean Michel Lhez and Julien Guillotreau have no disclosures to declare.

Research involving human participants and/or animals

Not applicable for that section.

Informed consent

All patients referred for BPO that required green laser enucleation of the prostate were included in this evaluation after providing informed written consent.

References

  1. 1.
    Lukacs B, Cornu JN, Aout M, Tessier N, Hodée C, Haab F, Cussenot O, Merlière Y, Moysan V, Vicaut E (2013) Management of lower urinary tract symptoms related to benign prostatic hyperplasia in real-life practice in France: a comprehensive population study. Eur Urol 64:493–501CrossRefPubMedGoogle Scholar
  2. 2.
    Gavras S, Drake MJ, Gratzke C, Madersbacher C, Tikkinen KAO, Mamoulakis C, Bach T, Gacci M, Herrmann TRW, Karavitakis M, Malde S, Sakalis V, Umbach R (2015) European Association of Urology. Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS) including benign prostate obstruction (BPO). http://uroweb.org/wp-content/uploads/EAU-Guidelines-Non-Neurogenic-Male-LUTS-Guidelines-2015-v2.pdf
  3. 3.
    Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67:1066–1096CrossRefPubMedGoogle Scholar
  4. 4.
    Bultitude M, Challacombe B (2015) Simple prostatectomy: a step too far for laparoscopy? Eur Urol 68:95–96CrossRefPubMedGoogle Scholar
  5. 5.
    Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, Cestari A, Briganti A, Mazzoccoli B, Rigatti P, Montorsi F (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol 50:563–568CrossRefPubMedGoogle Scholar
  6. 6.
    Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 53:160–166CrossRefPubMedGoogle Scholar
  7. 7.
    Krambeck AE, Handa SE, Lingeman JE (2013) Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 189(1 Suppl):S141–S145.  https://doi.org/10.1016/j.juro.2012.11.027 CrossRefPubMedGoogle Scholar
  8. 8.
    Meskawi M, Hueber PA, Valdivieso R, Bruyere F, Misrai V, Fournier G, Munver R, Sivarajan G, Rutman M, Te AE, Chughtai B, Elterman D, Martel T, Azizi M, Karakiewicz PI, Zorn KC (2017) Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc). World J Urol 35:1603–1609CrossRefPubMedGoogle Scholar
  9. 9.
    Gomez Sancha F, Rivera VC, Georgiev G, Botsevski A, Kotsev J, Herrmann T (2015) Common trend: move to enucleation—is there a case for GreenLight enucleation? Development and description of the technique. World J Urol 33:539–547CrossRefPubMedGoogle Scholar
  10. 10.
    Elshal AM, Elkoushy MA, El-Nahas AR, Shoma AM, Nabeeh A, Carrier S, Elhilali MM (2015) GreenLight™ laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 193:927–934CrossRefPubMedGoogle Scholar
  11. 11.
    Misrai V, Kerever S, Phe V, Zorn KC, Peyronnet B, Rouprêt M (2016) Direct comparison of GreenLight laser XPS photoselective prostate vaporization and GreenLight laser en bloc enucleation of the prostate in enlarged glands greater than 80 ml: a study of 120 patients. J Urol 195:1027–1032CrossRefPubMedGoogle Scholar
  12. 12.
    Misraï V, Faron M, Guillotreau J, Bruguière E, Bordier B, Shariat SF, Rouprêt M (2014) Assessment of the learning curves for photoselective vaporization of the prostate using GreenLight™ 180-watt-XPS laser therapy: defining the intra-operative parameters within a prospective cohort. World J Urol 32:539–544CrossRefPubMedGoogle Scholar
  13. 13.
    Misrai V, Bordier B, Guillotreau J (2017) Assessment of the learning curves for intravesical adenoma morcellation using Piranha(©) device during endoscopic enucleation. Prog Urol 27:33–37CrossRefPubMedGoogle Scholar
  14. 14.
    Peyronnet B, Robert G, Comat V, Rouprêt M, Gomez-Sancha F, Cornu JN, Misrai V (2017) Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World J Urol 35:973–983CrossRefPubMedGoogle Scholar
  15. 15.
    Witherington R, Shelor WC (1974) Suprapubic prostatectomy. Modified Hryntschak technique. Urology 4:550–556CrossRefPubMedGoogle Scholar
  16. 16.
    Mitropoulos D, Artibani W, Biyani CS, Bjerggaard Jensen J, Remzi M, Rouprêt M, Truss M (2014) Quality assessment of partial nephrectomy complications reporting using EAU standardised quality criteria. Eur Urol 66:522–526CrossRefPubMedGoogle Scholar
  17. 17.
    Peyronnet B, Cornu JN, Rouprêt M, Bruyere F, Misrai V (2015) Trends in the use of the GreenLight laser in the surgical management of benign prostatic obstruction in France over the past 10 years. Eur Urol 67:1193–1195CrossRefPubMedGoogle Scholar
  18. 18.
    Cockrell R, Lee DI (2017) Robot-assisted simple prostatectomy: expanding on an established operative approach. Curr Urol Rep 18:37CrossRefPubMedGoogle Scholar
  19. 19.
    Varkarakis I, Kyriakakis Z, Delis A, Protogerou V, Deliveliotis C (2004) Long-term results of open transvesical prostatectomy from a contemporary series of patients. Urology 64:306CrossRefPubMedGoogle Scholar
  20. 20.
    Tubaro A, Carter S, Hind A, Vicentini C, Miano L (2001) A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. J Urol 166:172CrossRefPubMedGoogle Scholar
  21. 21.
    Autorino R, Zargar H, Mariano M et al (2015) Perioperative outcomes of robotic and laparoscopic simple prostatectomy: a European-American multi-institutional analysis. Eur Urol 68:86–94CrossRefPubMedGoogle Scholar
  22. 22.
    Robert G, Cornu JN, Fourmarier M, Saussine C, Descazeaud A, Azzouzi AR, Vicaut E, Lukacs B (2016) Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int 117:495–499CrossRefPubMedGoogle Scholar
  23. 23.
    Bachmann A, Muir GH, Collins EJ, Choi BB, Tabatabaei S, Reich OM, Gómez-Sancha F, Woo HH (2012) 61 180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures. Eur Urol 61:600–607CrossRefPubMedGoogle Scholar
  24. 24.
    Endo F, Shiga Y, Minagawa S, Iwabuchi T, Fujisaki A, Yashi M, Hattori K, Muraishi O (2010) Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence. Urology 76:1451–1455CrossRefPubMedGoogle Scholar
  25. 25.
    Thomas JA, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Bachmann A (2016) A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol 69:94–102CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Vincent Misraï
    • 1
    Email author
  • Marie Pasquie
    • 1
  • Benoit Bordier
    • 1
  • Benjamin Elman
    • 1
  • Jean Michel Lhez
    • 1
  • Julien Guillotreau
    • 1
  • Kevin Zorn
    • 2
  1. 1.Department of UrologyClinique PasteurToulouseFrance
  2. 2.CHUM Section of Urology, Department of SurgeryUniversité de MontréalMontrealCanada

Personalised recommendations