Printer Friendly

Photoselective vaporization of the prostate with the 180-W XPS-Greenlight laser: Five-year experience of safety, efficiency, and functional outcomes.

Introduction

Benign prostatic hyperplasia (BPH) is a common condition diagnosed in men with increasing incidence after the age of 50. (1,2) Clinically, it manifests itself by progressive development of lower urinary tract symptoms (LUTS) that include voiding and storage disturbances. (1,2) The severity of BPH and the patient s degree of bothersome can be assessed by self-administered questionnaires as the I-PSS score. (1) Medical treatment should be offered to patients with moderate to severe symptoms (IPSS 8-35). According to the American and other international guidelines, surgery should be suggested as an option to patients having one or more of the following: urinary symptoms refractory to maximal medical therapy, gross hematuria, recurrent infections, bladder stones, or deterioration of kidney lunction. (1-3) Transurethral resection of the prostate (TURP) remains the gold standard treatment for LUTS secondary to BPH. (1) However, this intervention is associated with safety issues, particularly in patients taking anticoagulation therapy and those with larger prostates (> 80 cc). (4,5)

Over the past decades, Greenlight (GL) 532nm-laser photo selective vaporization of the prostate (PVP) has gained widespread acceptance as a safe and effective alternative to TURP. (3,6) This technology is based on a 532 nm length laser that vaporizes the highly vascularised transitional prostatic zone by selectively heating the hemoglobin. (7,8) In the year 2000, the first laser 80W KTP laser was commercialized. It was succeeded in 2006 by the 120W HPS system and most recently, in 2011, by the 180W Light XPS (GL-XPS). Studies have demonstrated that PVP was as safe and efficient as TURP with significant shorter catheterization and hospitalization times. (6,9,10) However, durability outcomes have been questioned for the initial 80W and 120W generation systems. (9) Despite the 180W XPS improved efficiency and short-term benefits, long-term data assessing BPH treatment durability is lacking. As such, we report the efficacy and safety of the 180W XPS system over a five-year experience and followup.

Methods

Patient characteristics

In this single institutional retrospective study, we prospectively collected data for 370 men who underwent 180W XPS GL (Boston Scientific, Boston, MA, USA) for BPH between 2011 and 2016. Patients with prostate cancer (n = 16) and those treated with the HPS GL (n = 38) were excluded from the analyses. Indications for treatment were based on the AUA BPH clinical guidelines. (1) Institutional-review board approval was obtained for the study.

Surgical procedures

All men were treated with the 180W XPS GL as previously reported. The surgeries were performed by a single experienced surgeon at our institution. The approach and technical procedure about the GL 180W XPS surgery is well described in Zorn et al. study published in 2011. (11,12)

Study design

All patients had PSA, IPSS, QoL, PVR, Qmax and transrectal ultrasound prostate volume assessment before surgery. Men were followed up at 3, 6, 12, 24, 36, 48 and 60 months. The outcomes of the patients were documented at each visit. The results were compared to preoperative values. Patients identify as dropout we scheduled for a 5 year visit. Complications were also prospectively described in this study. They included OAB symptoms, stress urinary incontinence, dysuria, urinary tract infection, urinary retention, hematuria, urethral strictures, and erectile dysfunction (EHS & SHIM scores). These complications were categorized according to the Clavien-Dindo classification. (13)

Statistical analyses

Means and standard deviations were reported for continuous variables, and proportions were used for nominal variables. Categories were compared using the Chi-square test and Fisher exact test for continuous variables. A p-value < 0.05 was considered as statistically significant. All analyses were performed using the SPSS software.

Results

After exclusion, the study included 370 men who underwent PVP using the GL 180W XPS. Patients were followed up for a period of 5 years (mean 59.4 months; CI [55.4 -63.5]; median: 56.3 months). However, only 66 patients (out of 370) had a complete 5-year follow up. The functional outcomes are comparable between the 66 patients and all other patients during the follow-up period (tables 3 and 4). The mean age of the patients was 68 years. Moreover, the mean prostate was 78.8 cc [70.9 - 78.7]. Mean operative time of the surgical procedures was 62.7 minutes [59.6 - 65.7] with a mean total energy expenditure of 270.2 kJ [255.2 - 285.2] per surgery. Thus, the average energy density utilization was 3.7 kJ/cc [3.6 - 3.9] in the entire cohort.

To note, 7 (1.9%) of the patients were on anticoagulation therapy at the time of surgery knowing that 135 men (36.5%) stopped anticoagulation days before surgery. Patients' perioperative characteristics are summarized in tables 1 and 2.

Functional outcomes were reported preoperatively and at 3, 6, 12, 24, 36, 48 and 60 months (tables 3 and 4). Retrospectively, at pre-op, the mean values for the IPSS, QOL, Qmax, and PVR were 26.2, 4.7, 5.5 mL/s, and 345 mL. After 5 years, the values recorded were 6.5, 1, 18.4 mL/s and 53.7 mL respectively. All functional outcomes significantly improved compared to baseline and appear to be maintained over the follow up period. With respect to the PSA, the average pre-operative value was 6.2 ng/mL compared to 2.5 ng/mL after 5 years (Figure 1).

Clavien-Dindo categorized adverse events are listed in table 5. At 3 months, 63 (18.8%) patients had treatment for irritative voiding symptoms with possible pre-existing OAB. This incidence dropped to 16 (8,46%) at 1 year and 0 at 5 years suggesting improvement of irritative voiding parameters after resolution of BOO post operatively. On the other hand, 5 (1.5%) patients had signs of bladder underactivity at 3 months. With respect to dysuria, 14 (4.7%) patients complained of burning sensation 3 months after the surgery compared to 0 patients after 4 years. 8 (2.4%) patients had urinary infections within 3 months postoperatively requiring antibiotic treatment. Concerning bladder neck contracture, cystoscopy confirmed its diagnosis in 2 patients within 6 months, and in 5 (2.6%) patients at 1 year. Only 2 men (0.5%) were reported to have clinically worsening erectile dysfunction at 6 months. Most important with respect to treatment durability, only 4 (1.1%) men required BPH retreatment: 1 at 1 year, 1 at 2 years and 2 at 4 years. Mean procedure prostate volume and kJ/ cc treatment were 87.3 cc and 3.9 kJ/cc in these patients.

Discussion

In 2011, Bachmann et al. were the first to report promising results on the efficiency and safety of the 180W XPS GL treatment for lower urinary tract symptoms. (14) As its predecessors, the 180W is a 532-nm lithium triporate laser, but it is equipped with a MoXy liquid-cooled fiber., (7,15) This innovative technology was created to enhance the efficiency, durability and safety of GL prostatectomy for patients with BPH. This technique can be offered in the long run to patients with large prostates rather than undergoing open prostatectomy. (15) Indeed, the 180-W GL safety has been upgraded by an infra-based feedback mechanism at the fiber-tip along with a new-pulsed coagulation device. Such features would allow the rapid control of bleeding intra-operatively. Furthermore, the increased output power allows improvement in the rate of vaporization and therefore a faster operative time. (7,16) Since its introduction to the urological armamentarium, several studies reported its superiority to monopolar TURP with shorter hospitalization, shorter catheterization time and faster time to clinical stability. (16,17)

More recent studies have demonstrated excellent outcome of 180W XPS GL PVP over a period of 2 years. (6) The current study is unique as it is the first study to the best of our knowledge to report 5-year durability outcomes. To note, only 66 patients (out of 370) had a complete 5-year follow up. In addition, it is important to mention that the patients treated had an average prostate size of 78.8 cc measured by TRUS preoperatively, which is significantly larger than in the Goliath trial (48.6 cc). All functional outcomes demonstrated and sustained significant improvement even after a period of 5 years. Similar

As mentioned previously, the Goliath study is the only prospective randomized clinical trial comparing 180W XPS and TURP with an exclusion of any patient in urinary retention. (6) At 2 years, they reported an IPSS score of 6.9, which suggests a drop of 14.3 points (67.5%) form baseline (21.2 points). Moreover, in our study preoperatively, the IPSS was 26.2 points with 46% of patients in urinary retention at the time of surgery. After initial rapid decline in IPSS postoperatively at 3 months (mean 7.7 points), future decline to nadir was observed at 3 years (mean IPSS of 5.1 points). This suggested the immediate relief of obstructive urinary symptoms with a delay recovery in bladder storage symptoms. At 5-year follow-up, the IPSS was 6.5, meaning a 75.2% (19.7 points) drop from baseline. Similarly, the reported QoL score was 1. This significant improvement was similar to the 71.1% drop (1.3 from 4.6) observed at 2 years in the GOLIATH study. (6)

With regards to urodynamic parameters, we observed that Qmax reached its maximal value at 1 year with an increase of 14.4 mL/s from 5.5 mL/s at baseline. At 5 years, the Qmax was 18.4 mL/s. Such results are comparable to Altay et al. study, which included 68 patients only with prostates larger than 80 mL, demonstrating a significant improvement at 1 year with a Qmax of 16 mL/s compared to 7.6 mL/s pre-op. Furthermore, Bachmann et al. reported an increase of 12.6 mL/s at 6 months with a preoperative Qmax of 8.4 mL/s. (14) When treated with TURP, the mean Qmax before the operation was 7.1 mL/s and reached 20.0 mL/s after 5 years. (18) This increase of 12.9 mL/s is comparable with the increase after 5 years of surgery with the 180W XPS. PVR is another parameter used to evaluate functional outcome following BPO surgery. Several components play a role in determining the value of the post void residue. Such components include the duration of BOO and its effect on the detrusor muscle. Other factors like prostatic regrowth, urethral strictures, the usage of anticholinergic medications and age-related detrusor contractibility influence bladder emptying. (1) In our study, the average PVR at 5 years was 53.7 mL compared to 345 mL preoperatively. The PVR nadir was reached at 4 years with a value of 32.8 mL (90.5% drop). The review of the literature made by Castellan et al. revealed that after a 3 and 6 month follow up the PVR decreased significantly. (17) Tasci and al showed that the PVR, after TURP, improved by 116.6 mL after 5 years. The mean PVR was 142 at baseline and 25.4 mL at 5 years. (18)

Moreover, PSA reduction has been established in the Holmium laser enucleation of the prostate (HoLEP) literature as a surrogate marker for BPH adenoma removal and thus is another useful parameter to assess the success and durability of BPO surgery. (19) In the present study, with 3.7 kJ/cc the PSA decreased from 6.2 ng/mL to 2.5 ng/mL after 5 years with a 59.3% drop. In comparison to the Goliath study, the PSA drop for the TURP group was around 57.7% from a preoperative value of 2.6 ng/mL. (6) BPH surgical retreatments was only 1% in our observed cohort.

As per international BPH guidelines, TURP is still the gold standard for surgical management of LUTS secondary to BPH for patients with prostate size < 80 cc, because of its efficacy and global access. Unfortunately, bleeding and long term durability are the Achilles heel to this procedure. Reich et al. evaluated the outcomes of 10,654 men who underwent TURP and demonstrated that morbidity and mortality increases with the increase in preoperative prostatic size. (5,20)

Moreover, Holmium laser enucleation of the prostate (HoLEP) is another well-established laser minimally invasive endo-surgical option for the management of BPH. HoLEP has been demonstrated as a size independent procedure with incredible long-term durable outcomes. (21) Table 5 compares outcomes for GL 80W, 120W, T URP and HoLEP. (18,22,23,24)

Complications are part of any surgical procedure. The most commonly reported complication was the clinical symptoms of OAB, which was observed in 63 patients (18.8%) 3 months after the surgery. 1 year post-op, only 16 patients were still medically treated for OAB suggesting BOO relief improvement in detrusor hyperactivity. After 5 years of follow-up, there were no complications reported. Bladder neck contracture has been observed in 1 - 12% after PVP or TURP and as high as 0.5 - 17.5% after radical prostatectomies. (25) In our study, a total of 7 men (1.9%) developed BNC during follow-up. Mean prostatic volume in such patients was 72 cc. Most were diagnosed within 6 months. The other 5 patients were diagnosed 1 year post-operatively. During our 5-year experience, 4 (1.1%) patients needed bladder neck resection; 1 after one year, 1 at two years, and 2 at four years. Comparatively, the rate of retreatment after TURP was estimated to be 7.6%. (6) In the literature, many studies didn't experience BNC, but they only had data collected for 30 days post-op. (26) Therefore, BNC is probably a late surgical complication.

Despite its merits, our study has certain limitations that need to be mentioned. Results are obtained from a retrospective analysis of a prospectively maintained database of single surgeon in a single institution. This is reflected in the loss at follow up at 4 and 5 years with only 42 (88.7% drop) and 66 (82.2%), respectively. However, the percentage of the patients participating in the study out of the number of eligible patients is 93% and 96% at 4 and 5 years, respectively. Despite these limitations we believe that our results indicate that 180W XPS GL PVP in experienced hands delivering volume appropriate energy ([greater than or equal to] 3 - 4 kJ/cc) is a safe, efficient, and durable procedure. (27) This article can be the backbone for counseling men more accurately and precisely before choosing the surgical procedure for small to medium size BPH.

Conclusion

Greenlight PVP can be considered a safe and durable procedure for patients with BPH needing surgical treatment. This study has shown the effectiveness of this procedure that can be maintained for a period of at least 5 years.

References

(1.) American Urological Association Education and Research Inc. American Urological Association Guideline: Management of benign prostatic hyperplasia (BPH) 2010. https://www.auanet.org/common/pdf/education/clinical-guidance/Benign-Prostatic-Hyperplasia.pdf Accessed February 1, 2017.

(2.) Nickel JC, Mendez-Probst CE, Whelan TF, Paterson RF, Razvi H. 2010 Update: Guidelines for the management of benign prostatic hyperplasia. Can Urol Assoc J. 2010;4(5):310-6.

(3.) Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015;67(6): 1099-109.

(4.) Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58(3):384-97.

(5.) Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008;180(1):246-9.

(6.) Thomas JA, Tubaro A, Barber N, dAncona F, Muir G, Witzsch U, et al. 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-yr Outcomes of the GOLIATH Study. Eur Urol. 2016;69(1):94-102.

(7.) Chughtai B, Te A. Photo selective vaporization of the prostate for treating benign prostatic hyperplasia. Expert Rev Med Devices. 2011;8(5):591-5.

(8.) Muller G, Bachmann A, Wyler SF. Vaporization techniques for benign prostatic obstruction: GreenLight all the way? Curr Opin Urol. 2014;24(1):42-8.

(9.) Thangasamy IA, Chalasani V, Bachmann A, Woo HH. Photoselective vaporisation of the prostate using 80-W and 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis from 2002 to 2012. Eur Urol. 2012;62(2):315-23.

(10.) Hueber PA, Liberman D, Ben-Zvi T, Woo H, Hai MA, Te AE, et al. 180 W vs 120 W lithium triborate photoselective vaporization of the prostate for benign prostatic hyperplasia: a global, multicenter comparative analysis of perioperative treatment parameters. Urology. 2013;82(5): 1108-13.

(11.) Zorn KC, Liberman D. GreenLight 180W XPS photovaporization of the prostate: how I do it. Can J Urol. 2011;18(5):5918-26.

(12.) Hueber PA, Liberman D, Ben-Zvi T, Woo H, Hai MA, Te AE, et al. 180 W vs 120 W lithium triborate photoselective vaporization of the prostate for benign prostatic hyperplasia: a global, multicenter comparative analysis of perioperative treatment parameters. Urology. 2013;82(5): 1108-13.

(13.) Peyronnet B, Pradere B, Brichart N, Bodin T, Bertrand P, Members of French Group of GreenLight U, et al. Complications associated with photoselective vaporization of the prostate: categorization by a panel of GreenLight users according to Clavien score and report of a single-center experience. Urology. 2014;84(3):657-64.

(14.) Bachmann A, Muir GH, Collins EJ, Choi BB, Tabatabaei S, Reich OM, et al. 180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures. Eur Urol. 2012;61(3):600-7.

(15.) Altay B, Erkurt B, Kiremit MC, Guzelburc V, Boz MY, Albayrak S. 180-W XPS GreenLight laser vaporization for benign prostate hyperplasia: 12-month safety and efficacy results for glands larger than 80 mL. Lasers Med Sci. 2015;30(1):317-23.

(16.) Brunken C, Seitz C, Woo HH. A systematic review of experience of 180-W XPS GreenLight laser vaporisation of the prostate in 1640 men. BJU Int. 2015;116(4):531-7.

(17.) Castellan P, Castellucci R, Schips L, Cindolo L. Safety, efficacy and reliability of 180-W GreenLight laser technology for prostate vaporization: review of the literature. World J Urol. 2015;33(5):599-607.

(18.) Tasci AI, Ilbey YO, Tugcu V, Cicekler O, Cevik C, Zoroglu F. Transurethral resection of the prostate with monopolar resectoscope: single-surgeon experience and long-term results of after 3589 procedures. Urology. 2011;78(5): 1151-5.

(19.) Hueber PA, Bienz MN, Valdivieso R, Lavigueur-Blouin H, Misrai V, Rutman M, et al. Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia Using the 180 Watt System: Multicenter Study of the Impact of Prostate Size on Safety and Outcomes. J Urol. 2015;194(2):462-9.

(20.) Madersbacher S, Lackner J, Brossner C, Rohlich M, Stancik I, Willinger M, et al. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol. 2005;47(4):499-504.

(21.) Alkan, Ilter, Hakan Ozveri, Yigit Akin, Tumay Ipekci, and Yusuf Alican. "Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up." International braz j urol 42.2 (2016): 293-301. Web.

(22.) Robert G, Cornu JN, Fourmarier M, Saussine C, Descazeaud A, Azzouzi AR, et al. Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int. 2016;117(3):495-9.

(23.) Guo S, Muller G, Lehmann K, Talimi S, Bonkat G, Puschel H, et al. The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective nonrandomized bi-center study. Lasers Med Sci. 2015;30(3): 1147-51.

(24.) Cho SY, Park S, Jeong MY, Ro YK, Son H. 120W GreenLight High Performance System laser for benign prostate hyperplasia: 68 patients with 3-year follow-up and analysis of predictors of response. Urology. 2012;80(2):396-401.

(25.) Hu B, Song Z, Liu H, Qiao L, Zhao Y, Wang M, et al. A comparison of incidences of bladder neck contracture of 80- versus 180-W GreenLight laser photoselective vaporization of benign prostatic hyperplasia. Lasers Med Sci. 2016;31(8): 1573-81.

(26.) Elshal AM, Elkoushy MA, El-Nahas AR, Shoma AM, Nabeeh A, Carrier S, et al. GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol. 2015;193(3):927-34.

(27.) Valdivieso, R, Meyer, C, Hueber, P, Meskawi, M, Alenizi, A, et al. Assessment Of Energy Density Usage During 180W Lithium Triborate Laser Photo-Selective Vaporization Of The Prostate For Benign Prostatic Hyperplasia. Is There An Optimal Amount Of Kilo-Joules Per Gram Of Prostate? The Journal of Urology, 2016; 195(4).

Figures and Tables

Khaled Ajib, MD (1); Mila Mansour (1); Marc Zanaty, MD (1); Mansour Alnazari, MD (1); Pierre-Alain Hueber, MD (1); Malek Meskawi, MD (1); Roger Valdivieso, MD (1); Come Tholomier (1,2); Benjamin Pradere, MD (3); Vincent Misrai, MD (4); Dean Elterman, MD, MSc, FRCSC (5); Kevin C. Zorn, MD, FRCSC

(1) Section of Urology, Department of Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada; (2) Department of Urology, McGill University, Montreal, QC, Canada; (3) Department of Urology, Centre Hospitalier Universitaire, Tours, France; (4) Department of Urology, Clinique Pasteur, Toulouse, France; (5) Division of Urology, University of Toronto, Toronto, ON, Canada

Cite as: Can Urol Assoc J 2018 March 19; Epub ahead of print. http://dx.doi.org/10.5489/cuaj.4895

Caption: Fig. 1. Functional outcomes. IPSS: International Prostate Symptom Score; PSA: prostate-specific antigen; PVR: post-void residual; Qmax: maximum flow rate; QoL: quality of life.
Table 1. Baseline characteristics

                      Number of              Mean   Confidence interval
                      patients

Age (years)           370                    67.8   66.9-68.7
BMI (kg/[m.sup.2])    370                    26.8   26.4-27.2
Prostate volume       370                    78.8   70.9-78.7
(cc)
Median lobe           138 (37.3%)
(preop
ultrasound or
cystoscopy)
Duration on [alpha]-  370                     2.01   1.8-2.2
adrenergic
blockers (years)
Duration on           241                     1.8    1.5-2.1
5-alpha reductase
inhibitors (years)
Retention with        170 (45.9%)
urethral catheter
at time of
surgery
Anticoagulation       135 (36.5%)
stopped before        Aspirin: 94
surgery and           clopidogrel: 5
resumed               Aspirin +
immediately           clopidogrel: 12
thereafter            Coumadin switched
                      to low molecular
                      weight heparin: 15
                      Dabigatran
                      etexilate: 6
                      Aspirin +
                      dabigatran etexilate:
                      3
Continued             7 (1.9%)
anticoagulation       Aspirin: 3
at time of            Aspirin +
surgery               clopidogrel: 3
                      Coumadin switched
                      to low molecular
                      weight heparin: 1

Table 2. Operative parameters

                  Number of  Mean    Confidence
                  patients           interval

Duration of       370         62.7    59.6-65.7
surgery (min)
Total energy      370        270.2   255.2-285.2
used (kJ)
Energy per g      370          3.7     3.6-3.9
(kJ/cc)
Number of         370          1.12    1.09-1.16
fibers used
Pathological      370          3.9     3.3-4.5
specimen
weight of
retrieved tissue
removed (g)
Hospital stay     370          0.7     0.5-0.8
(days)
Foley             370          1.1     1.0-1.2
catherization
(days)
Conversion to      10
TURP               (2.7%)

TURP: transurethral resection of the prostate.

Table 3. Outcomes of 180 XPS Greenlight

Outcomes  Preoperative               Months
                        3            6         12        24

PSA         6.2         NA          2.3        2.0        2.6
(ng/mL)     4.5-8.1                 1.9-2.6    1.8-2.3    2.3-2.9
IPSS       26.2          7.7        6.1        5.8        5.4
           25.6-26.8     7.2-8.2    5.7-6.5    5.3-6.3    4.9-5.9
QoL         4.7          1.3        1.02       0.9        0.9
            4.6-4.8      1.2-1.4    0.9-1.1    0.8-1.1    0.9-1.5
Qmax        5.5         19.9       20.2       19.9       19.8
(mL/s)      5.3-5.9     19.5-20.5  19.5-20.6  19.2-20.4  19.1-20.5
PVR (mL)  345           45.1       38.9       44.3       44.2
          320-370       36.2-54.5  31.1-46.8  33.5-55.1  29.9-55.5

Outcomes                    Months
           36           48         60         p

PSA         2.4         2.8        2.5       <0.001
(ng/mL)     1.7-3.1     1.4-4.0    0.3-4.0
IPSS        5.1         6.2        6.5       <0.001
            4.54-5.70   5.0-7.4    4.0-8.9
QoL         0.8         0.9        1.0       <0.001
            0.6-0.9     0.7-1.2    0.9-1.48
Qmax       19.5        19.3       18.4       <0.001
(mL/s)     17.8-19.8   17.7-20.8  16.5-20.4
PVR (mL)   40.4        32.8       53.7
           21.2-59.7   12.6-52.9  36.1-71.4  <0.001

IPSS: International Prostate Symptom Score; PSA: prostate-specific
antigen; PVR: post-void residual; Qmax: maximum flow rate; QoL: quality
of life.

Table 4. Outcomes of 180 XPS Greenlight of the 66 patients with
complete 5-year followup

Outcomes   Preoperative                 Months
                         3            6        12         24

PSA        11.9          NA          3.2        2.5        2.7
(ng/mL)     8.4-15.0                 1.5-4.9    1.4-3.7    1.5-3.9
IPSS       25.3           7.9        6.0        5.1        4.9
           23.5-26.8      6.8-9.1    5.1-6.9    4.3-7.8    4.3-5.5
QoL         4.5           1.3        0.9        0.9        0.8
            4.2-4.8       1.0-1.6    0.7-1.2    0.7-1.2    0.6-1.0
Qmax        4.5          20.3       20.5       20.3       20.8
(mL/s)      4.2-4.8      19.4-21.2  19.4-21.6  19.0-21.6  19.8-21.8
PVR (mL)   293.1         20.9       26.6       23.8       23.2
           229.9-356.2   11.2-30.6  12.9-20.3  12.6-34.9  10.6-35.7

Outcomes                         Months
               36         48         60          p

PSA             2.8        2.7        2.5       <0.001
(ng/mL)         1.7-3.8    1.6-3.8    0.3-4.0
IPSS            4.9        5.4        6.5       <0.001
                4.3-5.6    4.5-6.4    4.0-8.9
QoL             0.8        0.9        1.0       <0.001
                0.6-1.0    0.7-1.1    0.9-1.48
Qmax           18.8       16.8       18.4       <0.001
(mL/s)         17.7-19.9  15.6-18.1  16.5-20.4
PVR (mL)       43.7       55.5       53.7
               15.1-72.3  31.0-79.9  36.1-71.4  <0.001

IPSS: International Prostate Symptom Score; PSA: prostate-specific
antigen; PVR: post-void residual; Qmax: maximum flow rate; QoL: quality
of life.

Table 5. Complications of 180W XPS Greenlight

                                               Months
                                         3       6       12

                     Number of patients  336     221     189
                     Number of eligible  343     246     200
                     patients
Clavien-Dindo grade
Minor: I/II
                     OAB                  63      29      16
                     (%)                 (18.8)  (13.1)   (8.46)
                     SUI                  17       4       6
                     (%)                  (5.1)   (1.8)   (3.17)
                     Dysuria              14       4       3
                     (%)                  (4.6)   (1.8)   (1.6)
                     UTI                   8       3       2
                     (%)                  (2.4)   (1.4)   (1.1)
                     Bladder               5       3       1
                     underactivity/       (1.5)   (1.4)   (0.5)
                     retention
                     (%)
                     Hematuria             6       2       1
                     (%)                  (1.8)   (0.9)    0.5)
Major: IIIa/IIIb
                     Urethral stricture    0       1       2
                     (%)                          (0.5)   (1.1)
                     Bladder neck          1       1       5
                     contracture          (0.3)   (0.5)   (2.6)
                     (%)
                     BPH recurrence        0       0       1
                     requiring repeat                     (0.5)
                     BPO surgery
                     (%)

                                   Months
                     24       36     48     60

                     144      89     42     66
                     144      89     45     69
Clavien-Dindo grade
Minor: I/II
                      10       7      4      0
                      (6.9)   (7.9)  (9.5)
                       2       2      2      0
                      (1.4)   (2.2)  (4.8)
                       1       4      0      0
                      (0.7)   (4.5)
                       0       0      0      0
                       4       1      0      0
                      (2.8)   (1.1)
                       4       2      0      0
                      (2.8)   (2.2)
Major: IIIa/IIIb
                       0       0      0      0
                       0       0      0      0
                       1       0      2      0
                      (0.7)          (4.8)

BPH: bengign prostatic hyperplasia; BPO: benign prostatic obstruction;
OAB: overactive bladder; SUI: stress urinay incontinence; UTI: urinary
tract infection.

Table 6. Literature review of other modalities

Parameter    80W                     120W
             (Guo et al)             (Cho et al)
Number       120                     85
of patients
             Preoperative  60        Preoperative  36
                           months                  months

Mean          52.3         NA        50            NA
prostatic     33-72.6                33-67
volume
(cc)
Energy       225.8         NA        92.35         NA
delivery     129.6-332               16.5-168.2
(kJ/cc)
OR time       72.7         NA        60.3          NA
(min)         49.9-95.5              28.7-92.5
PSA            3.5          2.2       4            NA
(ng/ml)        0.1-7.1      0.3-4.1  0.8-7.2
IPSS          19.4          6.6
              13.1-25.7     4.7-8.5  21.7          13.4
                                     13.8-29.6     11-15.8
QoL            3.7          1.3                     2.3
               2-5.4        0-3.1     4.2           1.6-3
                                      3.0-5.4      13.9
Qmax           8.3          6.8                    12-14
(ml/s)         2.3-14.3     2.6-11    8.7
                                      5.6-11.8     35.3
PVR (ml)     119.5         34.5                    15-55
              35.7-203.3    0-114.5  93.5
BPH                        10.2       2.3-184.7    NA
retreatment
(%)
Mean                       12                      36
followup
(months)

Parameter      TURP                      HoLEP
               (Tasci et al)             (Elmansy et al)
Number         3589                      949
of patients
               Preoperative   120        Preoperative  120
                              months                   months

Mean            62.4          NA          81           NA
prostatic       50.4-74.4
volume
(cc)
Energy          NA            NA          96.0         NA
delivery
(kJ/cc)
OR time         42            NA          NA           NA
(min)           30.3-53.3
PSA              3.9           2.3         4.3          0.69
(ng/ml)          3-4.8         0.4-4.2
IPSS
                26             6.9        19            3.6
                23-29          2.8- 11     0-35         0-12
QoL
                 4             1.8         3.8          0.7
                 3-5           1.3-2.3     0-6          0-3
Qmax                          20
(ml/s)           7.1          11.5-28.5    8           26.9
                 4.7-9.5                   1.3-20       6.6-44.5
PVR (ml)                      25.4
               142            17.3-33.5  311           20.7
BPH            131-153                   102-500        0-654
retreatment                    4.4
(%)                                                     0.7
Mean
followup                      42 (*)                   62
(months)

BPH: bengign prostatic hyperplasia; IPSS: International Prostate
Symptom Score; OR: operating room; PSA: prostate-specific antigen;
PVR: post-void residual; Qmax: maximum flow rate; QoL: quality of life.


Please Note: Illustration(s) are not available due to copyright restrictions.
COPYRIGHT 2018 Canadian Urological Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2018 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Original Research
Author:Ajib, Khaled; Mansour, Mila; Zanaty, Marc; Alnazari, Mansour; Hueber, Pierre-Alain; Meskawi, Malek;
Publication:Canadian Urological Association Journal (CUAJ)
Article Type:Report
Geographic Code:1USA
Date:Jul 1, 2018
Words:4980
Previous Article:The role of neutrophil-lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma.
Next Article:Phase 1 pharmacokinetics and phase 3 efficacy of testosterone nasal gel in subjects with seasonal allergies.
Topics:

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters