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Standard vs. anatomical 180-W GreenLight laser photoselective vaporization of the prostate: a propensity score analysis

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Abstract

Purpose

To compare the efficacy, safety, Patient Global Impression of Improvement (PGI-I), and complications rates after 180-W GreenLight laser (180-W GL laser) standard and anatomical photoselective vaporization (sPVP and aPVP).

Methods

Within a multi-institutional database, we identified patients who underwent sPVP or aPVP to relief BPH symptoms. IPSS, Q max, and prostate-specific antigen (PSA) were measured at baseline and during the follow-up. PGI-I score as well as early and late complications were recorded at follow-up visits. Log-binomial and multivariable proportional odds regression models were fitted to estimate the effect of aPVP vs. sPVP on PGI-I as well as on early and late complication rates, before and after adjustment for propensity score.

Results

813 patients were included. Of those, the 50.4% underwent aPVP. Patients who underwent aPVP had larger prostate (64 vs. 55 mL, p < 0.001) and higher baseline PSA levels (3.1 vs. 2.5 ng/mL, p < 0.001). PGI-I score was signaled as very improved, improved, slightly improved, unchanged, or worsened in 55.5, 32.8, 8.3, 2.3, and 1.2% of the cases, respectively, with no differences according the technique used (p = 0.420). Acute urinary retention occurred in 9.2 vs. 8.9% of patients after aPVP vs. sPVP (p = 0.872). All models failed to find differences in: patients’ satisfaction (OR 1.19, p = 0.256), early complications (RR 0.93, p = 0.387), early urge/incontinence symptoms (RR 0.97, p = 0.814), and late complications rates (RR 0.70, p = 0.053), after aPVP vs. sPVP.

Conclusion

Our results showed similar functional results and complication rates after aPVP and sPVP. However, aPVP was used in larger prostates. Both techniques guarantee high patient’s satisfaction.

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Abbreviations

BPH/LUTS:

Benign prostatic hyperplasia/lower urinary tract symptoms

180-W XPS GL laser:

GreenLight XPS 180-W laser

PVP:

Photo-vaporization of the prostate

sPVP:

Standard PVP

aPVP:

Anatomical PVP

GreenLEP:

GreenLight laser enucleation of the prostate

IPSS:

International Prostate Symptom Score

Q max :

Maximum urinary flow

PVR:

Post-void residual of urine

OR:

Odds ratio

RR:

Relative risk

CI:

Confidence interval

HoLEP:

Holmium laser enucleation of prostate

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Acknowledgements

Members of Green Laser Italian Group: L. Cindolo, C. De Nunzio, M. Marchioni, F. Greco, P. Destefanis, B. Frea, F. Bergamaschi, S. Ricciardulli, G. Ferrari, G. Fasolis, F. Varvello, F. Palmieri, S. Voce, C. Divan, G. Malossini, R. Oriti, A. Tuccio, L. Ruggera, A. Tubaro, C. Dadone, G. De Rienzo, P. Ditonno, D. Campobasso, V. Mirone, A. Frattini, and L. Schips.

Author information

Authors and Affiliations

  1. Department of Urology, ASL Abruzzo2, Via S. Camillo de Lellis 1, 66054, Vasto, Chieti, Italy

    Luca Cindolo & Luigi Schips

  2. Department of Urology, “Sant’Andrea” Hospital, Sapienza University, Rome, Italy

    Cosimo De Nunzio & Andrea Tubaro

  3. Department of Urology, “Federico II” University, Naples, Italy

    Francesco Greco & Vincenzo Mirone

  4. Department of Urology, Azienda Ospedaliera Città della Salute e della Scienza di Torino-Sede Molinette, Turin, Italy

    Paolo Destefanis

  5. Department of Urology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy

    Franco Bergamaschi

  6. Department of Urology, “Hesperia” Hospital, Modena, Italy

    Giovanni Ferrari

  7. Department of Urology, “S. Lazzaro” Hospital, Alba, Italy

    Giuseppe Fasolis

  8. Department of Urology, Santa Maria delle Croci Hospital, Ravenna, Italy

    Fabiano Palmieri

  9. Department of Urology, Rovereto Hospital, Rovereto, Italy

    Claudio Divan

  10. Department of Urology, Ulivella e Glicini Clinic, Florence, Italy

    Rino Oriti

  11. Department of Urology, Clinica urologica azienda ospedaliera-University of Padova, Padua, Italy

    Lorenzo Ruggera

  12. Department of Urology, “Santa Croce e Carle” Hospital, Cuneo, Italy

    Claudio Dadone

  13. Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy

    Gaetano De Rienzo

  14. Department of Urology, “Ercole Franchini” Hospital, Montecchio Emilia, Italy

    Antonio Frattini

Authors
  1. Luca Cindolo
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  2. Cosimo De Nunzio
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  3. Francesco Greco
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  4. Paolo Destefanis
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  5. Franco Bergamaschi
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  6. Giovanni Ferrari
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  7. Giuseppe Fasolis
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  8. Fabiano Palmieri
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  9. Claudio Divan
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  10. Rino Oriti
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  11. Lorenzo Ruggera
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  12. Andrea Tubaro
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  13. Claudio Dadone
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  14. Gaetano De Rienzo
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  15. Antonio Frattini
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  16. Vincenzo Mirone
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  17. Luigi Schips
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Consortia

Members of Green Laser Italian Group

  • L. Cindolo
  • , C. De Nunzio
  • , M. Marchioni
  • , F. Greco
  • , P. Destefanis
  • , B. Frea
  • , F. Bergamaschi
  • , S. Ricciardulli
  • , G. Ferrari
  • , G. Fasolis
  • , F. Varvello
  • , F. Palmieri
  • , S. Voce
  • , C. Divan
  • , G. Malossini
  • , R. Oriti
  • , A. Tuccio
  • , L. Ruggera
  • , A. Tubaro
  • , P. Chiodini
  • , C. Dadone
  • , G. De Rienzo
  • , P. Ditonno
  • , D. Campobasso
  • , V. Mirone
  • , A. Frattini
  •  & L. Schips

Contributions

Cindolo, Greco, Ruggera, Destefanis, Ferrari, De Nunzio: project development, data analysis, and manuscript writing. All the authors: data collection. Schips, Mirone, Cindolo: supervision. All the authors: project development and manuscript editing.

Corresponding author

Correspondence to Luca Cindolo.

Ethics declarations

Conflict of interest

LC, LR, PD, CD, and 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.

Additional information

Members of Green Laser Italian Group are listed in the Acknowledgements section.

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

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  • DOI: https://doi.org/10.1007/s00345-017-2106-5

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