Safety and efficacy of GreenLight-XPS Laser vapo-enucleation in prostates measuring over 150mL: Beyond the Abstract
With the development of laser technology, new modalities such as Holmium Laser Enucleation of the Prostate (HoLEP) have emerged as minimally invasive alternatives that may provide durable long-term results in large prostates.3-5 However, HoLEP is a technically demanding procedure and has a substantial learning curve.6 Though the GreenLight XPS Laser System (GL-XPS) is a safe and efficacious alternative to TURP, which was importantly demonstrated in the GOLIATH trial,7 it has not been adequately studied in large prostates. In this study we sought to assess the safety and efficacy of the GL-XPS system using a combined vaporization-enucleation technique in patients with prostates over 150mL in size.
We included all consecutive men with prostates measuring over 150mL on preoperative transrectal ultrasound (TRUS) treated for BPH with the GL-XPS system at a tertiary referral center from September 2011 to October 2015. We measured efficacy of the procedure through the subjective symptom scores of International Prostate Symptom Score (IPSS) and quality of life (QoL), in addition to the objective voiding parameters of maximum urinary flow rate (Qmax) and postvoid residual (PVR). We evaluated safety through review of all adverse events related to primary treatment, and collected data on operative parameters and perioperative outcomes including length of hospitalization and catheterization.
In 70 patients with median prostate size 202mL (range 152-376mL), including 41 patients (59%) presenting in preoperative urinary retention, we demonstrate excellent and durable outcomes at 24-month follow-up. The improvements in IPSS, QoL, Qmax, and PVR were significant and compare favorably not only with the outcomes of GL-XPS in the GOLIATH trial and in studies of prostates over 80mL,7-10 but also with the reported outcomes of both HoLEP and SP in large prostates.4,11,12 In addition, the complication rates were low, with 94% of complications Clavien I/II in severity. There were no cases of conversion to electrocautery TURP for hemostasis and no cases of retreatment, which are common criticisms of the GL-XPS system in large prostates.13 Importantly, 86% of patients had a single-day hospital stay and 91% were discharged catheter free. The short duration of hospitalization and catheterization are commonly cited as a major advantage of GL-XPS,13 and we demonstrate that these advantages are preserved in this cohort of patients with very large prostates. Even among patients with preoperative urinary retention, 88% were discharged catheter-free.
This study provides compelling evidence that GL-XPS should be considered among the surgical treatment options for symptomatic BPH, regardless of prostate size. It is important to note that the vapo-enucleation technique utilized in this study vaporizes enucleated tissue to small fragments that can be extracted at the end of the case, negating the use of a mechanical morcellator. Finally, it should be noted that the study team is highly experienced with this particular vapo-enucleation technique and that large glands require experience and expertise to remove enough adenoma via a transurethral approach, which is a challenge with any technique.
Written by: Benjamin V. Stone*, Bilal Chughtai*, James C. Forde, Andrew W. Tam, Patrick Lewicki, Alexis E. Te
*denotes co-first author
References:
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