The GreenLight™ XPS Laser System (GL-XPS) is a safe and efficacious treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) but there is limited evidence on its use in prostates over 150mL.
We demonstrate the safety and efficacy of the GL-XPS system using a vapo-enucleation technique in prostate glands measuring over 150mL.
We prospectively collected data on all consecutive patients with prostates measuring over 150mL on transrectal ultrasound (TRUS) treated with the GL-XPS (AMS, Inc., Minnetonka, MN) at a tertiary referral center from September 2011 to October 2015. Data collected include prostate volume, IPSS and quality of life (QoL) scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate specific antigen (PSA), complications, and reintervention rates.
Seventy male patients with a median prostate size 202 mL (range 152-376mL) were included. There were 41 patients (59%) in preoperative urinary retention with an indwelling catheter preoperatively. Thirty-seven (53%) patients were American Society of Anesthesiologists (ASA) class 2 and 33 (47%) were class 3. Median operative time was 180 minutes, laser time 97 minutes, energy utilization 674kJ, and energy density 3.3kJ/mL, with median 3 fibers used per case. Median length of stay and length of catheterization were one day. IPSS and QoL scores demonstrated significant improvements from baseline at all endpoints, improving from 16 to 3.5 and from 4 to 1 at 24 months, respectively (p=0.001). At 12 months, Qmax and PVR improved from 10.1 mL/s to 22.4 mL/s (p=0.043) and from 84mL to 31.4mL (p=0.015), respectively. Retreatment was required in two patients (2.9%).
GL-XPS vapo-enucleation provided durable subjective and objective improvements in symptoms and voiding parameters, with no serious adverse events in men with prostates >150mL.
Journal of endourology / Endourological Society. 2016 May 20 [Epub ahead of print]
Benjamin V Stone, Bilal Chughtai, James C Forde, Andrew W Tam, Patrick Lewicki, Alexis E Te
Weill Cornell Medical College/NewYork-Presbyterian Hospital, Urology, New York, New York, United States ; ., Weill Cornell Medical College/NewYork-Presbyterian Hospital, Urology, New York, New York, United States ; ., Weill Cornell Medical College/NewYork-Presbyterian Hospital, Urology, New York, New York, United States ; ., Weill Cornell Medical College/NewYork-Presbyterian Hospital, Urology, New York, New York, United States ; ., Weill Cornell Medical College/NewYork-Presbyterian Hospital, Urology, New York, New York, United States ; ., Weill Cornell Medical College/NewYork-Presbyterian Hospital, Urology, New York, New York, United States ; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/27203515
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