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GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database

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Abstract

Purpose

We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database.

Methods

Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume.

Results

In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4–2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07–1.0, p = 0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6–152.6, p < 0.01).

Conclusion

We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.

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Funding

No funding or financial support was received for this study.

Author information

Author notes

  1. David-Dan Nguyen and Claudia Deyirmendjian have contributed equally.

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada

    David-Dan Nguyen

  2. Faculty of Medicine, Université de Montréal, Montreal, QC, Canada

    Claudia Deyirmendjian

  3. Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada

    Kyle Law, Naeem Bhojani & Kevin C. Zorn

  4. Division of Urology, University Health Network, Toronto, ON, Canada

    Dean S. Elterman

  5. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Bilal Chughtai

  6. Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France

    Franck Bruyère

  7. Department of Urology, Hesperia Hospital, “Cure Group”, Modena, Italy

    Luca Cindolo & Giovanni Ferrari

  8. Department of Urology, ABC Medical Center, Mexico City, Mexico

    Carlos Vasquez-Lastra

  9. Borelli Urologia, Ribeirão Presto, Sao Paulo, Brazil

    Tiago Borelli-Bovo

  10. Centro de Urologia, CDU, Buenos Aires, Argentina

    Edgardo F. Becher

  11. Prouro, Urology Berlin, Berlin, Germany

    Hannes Cash

  12. Department of Urology, University of Magdeburg, Magdeburg, Germany

    Hannes Cash

  13. Department of Urology, Charité—Universitaetsmedizin Berlin, Berlin, Germany

    Maximillian Reimann

  14. Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain

    Enrique Rijo

  15. Department of Urology, Clinique Pasteur, Toulouse, France

    Vincent Misrai

Authors
  1. David-Dan Nguyen
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  2. Claudia Deyirmendjian
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  3. Kyle Law
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  4. Naeem Bhojani
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  5. Dean S. Elterman
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  6. Bilal Chughtai
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  7. Franck Bruyère
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  8. Luca Cindolo
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  9. Giovanni Ferrari
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  11. Tiago Borelli-Bovo
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  12. Edgardo F. Becher
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  13. Hannes Cash
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  14. Maximillian Reimann
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  15. Enrique Rijo
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  16. Vincent Misrai
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  17. Kevin C. Zorn
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Contributions

DDN: protocol/project development, data analysis, manuscript writing. CD: protocol/project development, data analysis, manuscript writing. KL: data collection, manuscript writing/editing. NB: manuscript editing. DSE: manuscript editing. BC: data collection, manuscript editing. FB: data collection, manuscript editing. LC: data collection, manuscript editing. GF: data collection, manuscript editing. CV-L: data collection, manuscript editing. TB-B: data collection, manuscript editing. EFB: data collection, manuscript editing. HC: data collection, manuscript editing. MR: data collection, manuscript editing. ER: data collection, manuscript editing. VM: data collection, manuscript editing. KCZ: protocol/project development, data collection, manuscript editing.

Corresponding author

Correspondence to Kevin C. Zorn.

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Conflict of interest

Consultants and proctors for Boston Scientific for Greenlight: Zorn, Elterman, Misrai, Rijo, Cash, Chughtai. Surgical tutors for Greenlight Xcelerated Performance System and received honoraria for their tutorship: Ferrari, Cindolo. Investigators and consultants for PROCEPT BioRobotics: Misrai, Borelli-Bovo, Bhojani, Zorn. All other authors do not have any relevant conflicts of interest. Furthered by Dr. Kevin Zorn INC.

Research involving human participants and/or animals

This is a study involving retrospective review of participants. IRB approval has been obtained.

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Nguyen, DD., Deyirmendjian, C., Law, K. et al. GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database. World J Urol 40, 1755–1762 (2022). https://doi.org/10.1007/s00345-022-03986-5

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  • DOI: https://doi.org/10.1007/s00345-022-03986-5

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