Abstract
Introduction
The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians.
Methods
The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80.
Results
Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9 ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Qmax) that favoured younger patients (10.3 vs 12.6 ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6–18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01).
Conclusions
GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.
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Data availability
The datasets generated during and/or analyzed during the current study are readily available from the corresponding author upon request.
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CD: project development, data collection, manuscript writing and editing. DDN: project development, data collection, data analysis, manuscript writing and editing. KWL: project development, data collection, manuscript writing and editing. ALVN: project development, data collection, manuscript writing and editing. IS: project development, data collection, manuscript writing and editing. AA: project development, data collection, manuscript writing and editing. DB: project development, data collection, manuscript writing and editing. AI: project development, data collection, manuscript writing and editing. NB: project development, data collection, manuscript writing and editing. DSE: project development, data collection, manuscript writing and editing. BC: project development, data collection, manuscript writing and editing. FB: project development, data collection, manuscript writing and editing. LC: project development, data collection, manuscript writing and editing. GF: project development, data collection, manuscript writing and editing. CV-L: project development, data collection, manuscript writing and editing. TB-B: project development, data collection, manuscript writing and editing. EFB: project development, data collection, manuscript writing and editing. HC: project development, data collection, manuscript writing and editing. MR: project development, data collection, manuscript writing and editing. ER: project development, data collection, manuscript writing and editing. VM: project development, data collection, manuscript writing and editing. KCZ: project development, data collection, manuscript writing and editing.
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Conflict of interest
Consultants and proctors for Boston Scientific for GreenLight: KZ, DSE, VM, ER, HC, BC. Surgical tutors for GreenLight Xcelerated Performance System and received honoraria for their tutorship: GF, LC. Investigators and consultants for PROCEPT BioRobotics: VM, TB, NB, KZ. All other authors do not have any relevant conflicts of interest.
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All the procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standard.
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Deyirmendjian, C., Nguyen, DD., Law, K.W. et al. Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database. World J Urol 41, 1133–1140 (2023). https://doi.org/10.1007/s00345-023-04334-x
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DOI: https://doi.org/10.1007/s00345-023-04334-x