Abstract
Purposes
GreenLight laser has gained increasing acceptance as a less invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS). Three surgical options were developed: standard photovaporization (PVP), anatomical PVP and GreenLight enucleation of prostate (GreenLEP); however, literature lacks a direct comparison among the procedures. Aim of the present study is to compare the three techniques in a multicentre series of patients.
Methods
Data were collected from consecutive patients with indication to surgical management of BPH/LUTS in five institutions. Patients underwent standard PVP, anatomical PVP or GreenLEP according to surgeon preferences. Standard parameters associated with transurethral prostate surgery were documented prior surgery and during the follow-up. Patients’ perception of improvement was measured using a single-item scale. Early (within first 30 post-operative days) and delayed post-operative complications were recorded. Descriptive statistics, univariate and multivariate analysis were used.
Results
We evaluate 367 consecutive patients (mean age 69.1 years). Median prostate size and PSA were 68 ml (IQR 50–90) and 2.8 ng/ml (IQR 1.7–4.3), respectively. The median operative time and applied energy were 60 min (IQR 45–75) and 250 kJ (IQR 160–364). Catheterization time and median post-operative stay were 1 and 2 days. No patient was transfused. The overall median Q max values increased for 8–19 ml/s (p < 0.05), median International Prostate Symptoms Score decreased from 24 to 7 (p < 0.05). A total of 7.4% urinary retention, 33.4% bothersome storage symptoms, 2.5% short-term stress incontinence were recorded. Three heart attacks, one pulmonary embolism and one death occurred. Prostate volume was a predictive factor for post-operative storage symptoms (p = 0.049). Nine percentage of patients experienced long-term complications (4, 0.9 and 0.9% of urethral stricture, bladder neck contracture and prostatic fossa sclerosis, respectively) with 2.5% of long-term stress urinary incontinence (conservatively managed). The reintervention rate was 6%. Late complications were associated at univariate analysis with pharmacological therapy (combination therapy vs. alpha blockers alone vs. none: p value = 0.042) and with the surgical approach (standard PVP vs. anatomical PVP vs. GreenLEP p value = 0.011). The patients’ perception of satisfaction was 68% “greatly improved”, 27% “improved”, 4% “not changed” and 1% “worsened” with no differences between techniques.
Conclusion
The availability of three different GreenLight laser techniques allows surgeons with different skills to safety use this technology that remains effective with high patient satisfaction. Anatomical vaporization seems to guarantee the best balance between functional outcomes, surgical procedures and complications.
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Abbreviations
- BPH:
-
Benign prostatic hyperplasia
- LUTS:
-
Lower urinary tract symptoms
- 180-W XPS GL laser:
-
GreenLight XPS 180-W laser
- PVP:
-
Photovaporization of the prostate
- 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
- CI:
-
Confidence interval
- LMWH:
-
Low molecular weight heparin
- HoLEP:
-
Holmium laser enucleation of prostate
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Authors’ contributions
LC and GF contributed to project development, data analysis and manuscript writing. LC, LR, PD, CD and GF collected the data. CD and GF involved in supervision. LC and PD performed project development, manuscript writing and editing.
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All the authors do surgical tutorship for AMS and received honoraria for their tutorship.
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For this type of study formal consent is not required.
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Informed consent was obtained from all individual participants included in the study.
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Cindolo, L., Ruggera, L., Destefanis, P. et al. Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser. Int Urol Nephrol 49, 405–411 (2017). https://doi.org/10.1007/s11255-016-1494-6
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DOI: https://doi.org/10.1007/s11255-016-1494-6