Abstract
Purpose
To compare the perioperative and functional outcomes between 180_W XPS GreenLight photoselective vaporization (PVP) and 532-nm GreenLight laser enucleation of the prostate (GreenLEP) in the surgical management of benign prostatic obstruction (BPO).
Methods
Retrospective review of a prospectively maintained international database of patients managed with GreenLight laser surgery (PVP or GreenLEP) was performed. To adjust for potential baseline confounders, propensity-score matching (PSM) was applied at a ratio of 1:1 to compare the perioperative and functional outcomes between the groups.
Results
A total of 2,420 patients were included. 1,491 (61.6%) underwent PVP and 929 (38.4%) underwent GreenLEP. Before PSM analysis, patients in the vaporization group were older (p < 0.001), had a lower PSA and prostate volume at baseline (p < 0.001). Using estimated propensity scores, 78 patients in the PVP group were matched 1:1 to the patients in the GreenLEP group. The incidence of overall postoperative complications was comparable between the two groups (19 vs. 16%, p = 0.06). However, after PSM, PVP was found to be associated with a higher rate of overall complications (33 vs. 11%, p = 0.001). At 3 months and at last follow-up the I-PSS, Qmax and PSA had similarly decreased in the two groups with a greater improvement in the GreenLEP group (all p < 0.05).
Conclusions
PVP and GreenLEP are two efficient and safe techniques for treating BPO. However, PVP was associated with longer operative time and higher risk of reoperation on a midterm follow-up compared to GreenLEP.
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References
Foo KT (2019) What is a disease? What is the disease clinical benign prostatic hyperplasia (BPH)? World J Urol 37:1293–1296. https://doi.org/10.1007/s00345-019-02691-0
Cornu J-N, Ahyai S, Bachmann A et al (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 67:1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017
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 53:160–166. https://doi.org/10.1016/j.eururo.2007.08.036
Tooher R, Sutherland P, Costello A et al (2004) A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia. J Urol 171:1773–1781. https://doi.org/10.1097/01.ju.0000113494.03668.6d
Thomas JA, Tubaro A, Barber N et al (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-year outcomes of the GOLIATH study. Eur Urol 69:94–102. https://doi.org/10.1016/j.eururo.2015.07.054
Nguyen D-D, Misraï V, Bach T et al (2020) Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP. World J Urol. https://doi.org/10.1007/s00345-020-03137-8
Al-Ansari A, Younes N, Sampige VP et al (2010) GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. Eur Urol 58:349–355. https://doi.org/10.1016/j.eururo.2010.05.026
Naspro R, Sancha FG, Manica M et al (2017) From “gold standard” resection to reproducible “future standard” endoscopic enucleation of the prostate: what we know about anatomical enucleation. Minerva Urol Nefrol 69:13
Khene Z-E, Peyronnet B, Vincendeau S et al (2020) The surgical learning curve for endoscopic GreenLightTM laser enucleation of the prostate: an international multicentre study. BJU Int 125:153–159. https://doi.org/10.1111/bju.14904
Jaeger CD, Mitchell CR, Mynderse LA, Krambeck AE (2015) Holmium laser enucleation (HoLEP) and photoselective vaporisation of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH) and chronic urinary retention. BJU Int 115:295–299. https://doi.org/10.1111/bju.12674
Castellani D, Cindolo L, De Nunzio C et al (2018) Comparison between thulium laser vapoenucleation and GreenLight laser photoselective vaporization of the prostate in real-life setting: propensity score analysis. Urology 121:147–152. https://doi.org/10.1016/j.urology.2018.09.007
Vincent M, Sebastien K, Veronique P et al (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 195:1027–1032. https://doi.org/10.1016/j.juro.2015.10.080
Gomez Sancha F, Rivera VC, Georgiev G et al (2015) Common trend: move to enucleation-is there a case for GreenLight enucleation? Development and description of the technique. World J Urol 33:539–547. https://doi.org/10.1007/s00345-014-1339-9
Rijo E, Misrai V (2020) En bloc GreenLight laser enucleation of the prostate (GreenLEP): An in-depth look at the anatomical endoscopic enucleation of the prostate using a 532-nm lithium triborate laser. Andrologia 52:e13729. https://doi.org/10.1111/and.13729
Rijo E, Misrai V, Aho T, Gomez-Sancha F (2018) Recommendations for safe and efficient morcellation after endoscopic enucleation of the prostate. Urology 121:197. https://doi.org/10.1016/j.urology.2018.06.027
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College Station
Parsons JK, Dahm P, Köhler TS et al (2020) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2020. J Urol 204:799–804. https://doi.org/10.1097/JU.0000000000001298
Cornu J-N (2016) Bipolar, monopolar, photovaporization of the prostate, or holmium laser enucleation of the prostate: how to choose what’s best? Urol Clin North Am 43:377–384. https://doi.org/10.1016/j.ucl.2016.04.006
Mordasini L, Moschini M, Mattei A, Iselin C (2018) GreenLight laser for benign prostatic hyperplasia. Curr Opin Urol 28:322–328. https://doi.org/10.1097/MOU.0000000000000500
Sandhu JS, Leong JY, Das AK (2019) Photoselective vaporization of the prostate: application, outcomes and safety. Can J Urol 26:8–12
Misraï V, Pasquie M, Bordier B et al (2018) Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience. World J Urol 36:793–799. https://doi.org/10.1007/s00345-018-2192-z
Peyronnet B, Robert G, Comat V et al (2017) Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World J Urol 35:973–983. https://doi.org/10.1007/s00345-016-1957-5
Valdivieso R, Meyer CP, Hueber P-A et al (2016) Assessment of energy density usage during 180W lithium triborate laser photoselective vaporization of the prostate for benign prostatic hyperplasia. Is there an optimum amount of kilo-Joules per gram of prostate? BJU Int 118:633–640. https://doi.org/10.1111/bju.13479
Bachmann A, Muir GH, Collins EJ et al (2012) 180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures. Eur Urol 61:600–607. https://doi.org/10.1016/j.eururo.2011.11.041
Zhang KY, Xing JC, Chen BS, Liu CX, Lau HW, Sim HG, Foo KT (2011) Bipolar plasmakinetic transurethral resection of the prostate vs. transurethral enucleation and resection of the prostate: pre- and postoperative comparisons of parameters used in assessing benign prostatic enlargement. Singap Med J 52(10):747–687514 (PMID: 22009396)
Elshal AM, Soltan M, El-Tabey NA et al (2020) Randomized trial of bipolar resection vs. Holmium laser enucleation vs. Greenlight laser vapo-enucleation of the prostate for treatment of large sized benign prostate obstruction; 3-years outcome. BJU Int. https://doi.org/10.1111/bju.15161
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All authors: Project development. Gasmi, Guérin, Misrai: Data collection. Gasmi, Guérin, Misrai, Khene, Bensalah, Roupret, Peyronnet, Mathieu, Rijo: Data analysis. All authors: Manuscript editing.
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Gasmi, A., Khene, ZE., Guérin, S. et al. Propensity-score analysis comparing perioperative and functional outcomes between XPS 180 W-photovaporization and GreenLight laser enucleation of the prostate: reasons to discard vaporization and move to enucleation. World J Urol 39, 2269–2276 (2021). https://doi.org/10.1007/s00345-021-03590-z
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DOI: https://doi.org/10.1007/s00345-021-03590-z