Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Perioperative major acute cardiovascular events after 180-W GreenLight laser photoselective vaporization of the prostate

  • 135 Accesses

  • 3 Citations



Major acute cardiovascular events (MACE) prevalence after 180-W GreenLight (180-W GL) laser photoselective vaporization (PVP) have never been explored. Aim of our study is to evaluate perioperative MACE that occurred concomitantly with 180-W GL PVP.

Materials and methods

We relied on a multi-institutional database that included 14 centers. Data from 923 patients who underwent 180-W GL PVP were reviewed. We abstracted pre- and perioperative data of patients who experienced perioperative MACE, such as angina pectoris, acute myocardial infarction, other chronic ischemic heart disease, transient ischemic attack, or cerebrovascular accident as well as deep venous thrombosis with or without pulmonary embolism. We relied on a case-series format to report the main findings of our analyses.


18 (1.9%) patients reported MACE in 7 centers. Median age was 69.5 (IQR 66.0–79.2) years. Of all, 7 patients underwent standard PVP and 11 anatomical PVP. Eleven patients (61.1%) were not under anticoagulant/antiplatelet treatment, 6 (33.3%) were under low dose aspirin, and 1 (5.6%) was under clopidogrel. Four patients (22.2%) had an instrumental and laboratory diagnosis of myocardial infarction, 7 (38.9%) had an episode of angina pectoris with or without rhythm alteration, 3 (16.7%) reported symptomatic deep venous thrombosis, and 4 (22.2%) had other MACE-like events.


Physician should take in consideration the possibility of MACE or MACE-like events. The real MACE rate may be different as only half of included centers reported MACE. Since the main target of laser surgery are high-risk bleeding patients, prospective observational trials focused on detection of these possible complications are warranted.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Gacci M, Corona G, Sebastianelli A et al (2016) Male lower urinary tract symptoms and cardiovascular events: a systematic review and meta-analysis. Eur Urol 70(5):788–796. https://doi.org/10.1016/j.eururo.2016.07.007

  2. 2.

    Cindolo L, Pirozzi L, Fanizza C et al (2015) Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study. Eur Urol 68(3):418–425. https://doi.org/10.1016/j.eururo.2014.11.006

  3. 3.

    Gravas S, Bach T, Bachmann A et al (2015) EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Uroweb. http://uroweb.org/wp-content/uploads/EAU-Guidelines-Non-Neurogenic-Male-LUTS_LR.pdf. Accessed 30 August 2016

  4. 4.

    NICE Guidance (2017) GreenLight XPS for treating benign prostatic hyperplasia. BJU Int 119(6):823–830. https://doi.org/10.1111/bju.13897

  5. 5.

    van Waes JAR, Nathoe HM, de Graaff JC et al (2013) Myocardial injury after noncardiac surgery and its association with short-term mortality. Circulation 127(23):2264–2271. https://doi.org/10.1161/CIRCULATIONAHA.113.002128

  6. 6.

    Smilowitz NR, Gupta N, Ramakrishna H, Guo Y, Berger JS, Bangalore S (2017) Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery. JAMA Cardiol 2(2):181. https://doi.org/10.1001/jamacardio.2016.4792

  7. 7.

    Cindolo L, De Nunzio C, Greco F et al (2018) Standard vs. anatomical 180-W GreenLight laser photoselective vaporization of the prostate: a propensity score analysis. World J Urol 36(1):91–97. https://doi.org/10.1007/s00345-017-2106-5

  8. 8.

    Cindolo L, Ruggera L, Destefanis P, Dadone C, Ferrari G (2017) Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser. Int Urol Nephrol 49(3):405–411. https://doi.org/10.1007/s11255-016-1494-6

  9. 9.

    Bhojani N, Gandaglia G, Sood A et al (2014) Morbidity and mortality after benign prostatic hyperplasia surgery: data from the American College of Surgeons national surgical quality improvement program. J Endourol 28(7):831–840. https://doi.org/10.1089/end.2013.0805

  10. 10.

    Raj MD, McDonald C, Brooks AJ et al (2011) Stopping anticoagulation before TURP does not appear to increase perioperative cardiovascular complications. Urology 78(6):1380–1384. https://doi.org/10.1016/j.urology.2011.05.053

  11. 11.

    Taylor K, Filgate R, Guo DY, Macneil F (2011) A retrospective study to assess the morbidity associated with transurethral prostatectomy in patients on antiplatelet or anticoagulant drugs. BJU Int 108:45–50. https://doi.org/10.1111/j.1464-410X.2011.10686.x

  12. 12.

    Bell CR, Murdock PJ, Pasi KJ, Morgan RJ (1999) Thrombotic risk factors associated with transurethral prostatectomy. BJU Int 83(9):984–989

  13. 13.

    Wettstein MS, Poyet C, Grossmann NC et al (2016) Absorption of irrigation fluid during XPS™ GreenLight laser vaporization of the prostate: results from a prospective breath ethanol monitoring study. World J Urol 34(9):1261–1267

  14. 14.

    Müllhaupt G, Abt D, Mordasini L et al (2017) Absorption of irrigation fluid during thulium laser vaporization of the prostate. J Endourol 31(4):380–383. https://doi.org/10.1089/end.2016.0888

  15. 15.

    Hermanns T, Grossmann NC, Wettstein MS et al (2015) Absorption of irrigation fluid occurs frequently during high power 532 nm laser vaporization of the prostate. J Urol 193(1):211–216. https://doi.org/10.1016/j.juro.2014.07.117

  16. 16.

    Hahn RG (2013) Glycine 1.5% for irrigation should be abandoned. Urol Int 91(3):249–255. https://doi.org/10.1159/000354933

  17. 17.

    Zhang W, Andersson BS, Hahn RG (1995) Effect of irrigating fluids and prostate tissue extracts on isolated cardiomyocytes. Urology 46(6):821–824

  18. 18.

    Devereaux PJ, Sessler DI (2015) Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med 373(23):2258–2269. https://doi.org/10.1056/NEJMra1502824

Download references

Author information

MM, LC, FG: Project development, Data analysis, Manuscript writing. All the authors: Data collection. LS, LC, GF: Supervision. All the authors: Project development, Manuscript editing.

Correspondence to Luca Cindolo.

Ethics declarations

Conflict of interest

LC, LR, PD, GF do surgical tutorship for AMS and received honoraria for their tutorship.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study. This study and all the related procedures have been performed in accordance with the Declaration of Helsinki.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Marchioni, M., Schips, L., Greco, F. et al. Perioperative major acute cardiovascular events after 180-W GreenLight laser photoselective vaporization of the prostate. Int Urol Nephrol 50, 1955–1962 (2018). https://doi.org/10.1007/s11255-018-1968-9

Download citation


  • Major acute cardiovascular events
  • Photoselective vaporization of the prostate
  • BPH
  • Cardiovascular safety
  • Transurethral surgery of the prostate
  • Green light laser