Top

Published in:

26-03-2022 | Original Article

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

Authors: David-Dan Nguyen, Claudia Deyirmendjian, Kyle Law, Naeem Bhojani, Dean S. Elterman, Bilal Chughtai, Franck Bruyère, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo F. Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, Kevin C. Zorn

Published in: World Journal of Urology | Issue 7/2022

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.

Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132(3):474–479. https://doi.org/10.1016/S0022-5347(17)49698-4CrossRefPubMed

Hutchison A, Farmer R, Verhamme K, Berges R, Navarrete RV (2007) The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries. Eur Urol 51(1):207–216. https://doi.org/10.1016/J.EURURO.2006.06.012CrossRefPubMed

Welliver C, Essa A (2016) Sexual side effects of medical and surgical benign prostatic hyperplasia treatments. Urol Clin 43(3):393–404. https://doi.org/10.1016/J.UCL.2016.04.010CrossRef

Lusty A, Siemens DR, Tohidi M, Whitehead M, Tranmer J, Nickel JC (2021) Cardiac failure associated with medical therapy of benign prostatic hyperplasia: a population based study. J Urol 205(5):1430–1437. https://doi.org/10.1097/JU.0000000000001561CrossRefPubMed

Cindolo L, Pirozzi L, Fanizza C et al (2015) Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study. Eur Urol 68(3):418–425. https://doi.org/10.1016/j.eururo.2014.11.006CrossRefPubMed

Manfredi C, Arcaniolo D, Spatafora P et al (2021) Emerging minimally invasive transurethral treatments for benign prostatic hyperplasia: a systematic review with meta-analysis of functional outcomes and description of complications. Minerva Urol Nephrol. https://doi.org/10.23736/s2724-6051.21.04530-4CrossRefPubMed

LaRussa S, Pantuck M, Vanden Burg RW, Gaffney CD, Askin G, McClure T (2021) Symptomatic improvement of lower urinary tract symptoms of benign prostatic hyperplasia: a comparative systematic review and meta-analysis of four different minimally invasive therapies. J Vasc Interv Radiol Published online. https://doi.org/10.1016/j.jvir.2021.06.019CrossRef

Marchioni M, Cindolo L, Di NM et al (2019) Prostatic diseases and male voiding dysfunction major acute cardiovascular events after transurethral prostate surgery: a population-based analysis. Urology 131:196–203. https://doi.org/10.1016/j.urology.2019.05.014CrossRefPubMed

Meskawi M, Hueber P-A, Valdivieso R et al (2019) Complications and functional outcomes of high-risk patient with cardiovascular disease on antithrombotic medication treated with the 532-nm-laser photo-vaporization Greenlight XPS-180 W for benign prostate hyperplasia. World J Urol 37:1671–1678. https://doi.org/10.1007/s00345-018-2560-8CrossRefPubMed

10.

Lee DJ, Rieken M, Halpern J et al (2016) Laser vaporization of the prostate with the 180-W XPS-greenlight laser in patients with ongoing platelet aggregation inhibition and oral anticoagulation. Urology 91:167–173. https://doi.org/10.1016/j.urology.2016.01.021CrossRefPubMed

11.

Rajih E, Tholomier C, Hueber PA et al (2017) Evaluation of surgical outcomes with photoselective GreenLight XPS laser vaporization of the prostate in high medical risk men with benign prostatic enlargement: a multicenter study. J Endourol 31:686–693. https://doi.org/10.1089/end.2016.0782CrossRefPubMed

12.

Bouhadana D, Nguyen D-D, Zhang X et al (2021) Safety and efficacy of TURP vs laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75. World J Urol. https://doi.org/10.1007/S00345-021-03779-2CrossRefPubMed

13.

Law KW, Tholomier C, Nguyen D-D et al (2021) Global greenlight group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety. World J Urol. https://doi.org/10.1007/s00345-021-03688-4CrossRefPubMed

14.

Doyle DJ, Garmon EH (2021) American Society of Anesthesiologists Classification (ASA Class). StatPearls Publishing; 2018. Accessed July 28 https://www.ncbi.nlm.nih.gov/books/NBK441940/

15.

Haeuser L, Herzog P, Ayub A et al (2021) Comparison of comorbidity indices for prediction of morbidity and mortality after major surgical procedures. Am J Surg. https://doi.org/10.1016/j.amjsurg.2021.04.007CrossRefPubMed

16.

LaBossiere JR, Wallis CJD, Herschorn S, Carr L, Saskin R, Nam R (2020) Surgical management of benign prostatic obstruction: 20-year population-level trends. Can Urol Assoc J 14(8):552–557. https://doi.org/10.5489/CUAJ.6224CrossRef

17.

Piotrowicz G, Syryło T, Jedynak R, Zieliński H (2018) Efficacy and safety of photoselective vaporization of the prostate with 120 W 532 nm laser in patients with benign prostatic hyperplasia on anticoagulation or antiplatelet therapy: observations on long-term outcomes. Photomed Laser Surg 36(5):273–283. https://doi.org/10.1089/pho.2017.4367CrossRefPubMed

18.

Eken A, Soyupak B (2018) Safety and efficacy of photoselective vaporization of the prostate using the 180-W GreenLight XPS laser system in patients taking oral anticoagulants. J Int Med Res 46(3):1230–1237. https://doi.org/10.1177/0300060517747489CrossRefPubMedPubMedCentral

19.

Parsons J, Dahm P, Köhler T et al (2020) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment. J Urol 2020:799–804CrossRef

20.

Gravas S, Cornu J, Gacci M, et al. EAU Guidelines Edn presented at the EAU Annual Congress Milan 2021. EAU Guidel Off.

21.

Barco-Castillo C, Plata M, Zuluaga L et al (2020) Functional outcomes and safety of GreenLight photovaporization of the prostate in the high-risk patient with lower urinary tract symptoms due to benign prostatic enlargement. Neurourol Urodyn 39(1):303–309. https://doi.org/10.1002/nau.24195CrossRefPubMed

22.

Sankar A, Johnson SR, Beattie WS et al (2014) Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth 113(3):424–432. https://doi.org/10.1093/bja/aeu100CrossRefPubMedPubMedCentral

Title: GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database
Authors: David-Dan Nguyen
Claudia Deyirmendjian
Kyle Law
Naeem Bhojani
Dean S. Elterman
Bilal Chughtai
Franck Bruyère
Luca Cindolo
Giovanni Ferrari
Carlos Vasquez-Lastra
Tiago Borelli-Bovo
Edgardo F. Becher
Hannes Cash
Maximillian Reimann
Enrique Rijo
Vincent Misrai
Kevin C. Zorn
Publication date: 26-03-2022
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 7/2022
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-022-03986-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2022

The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind?

Incidence and safety outcomes associated with active stone removal procedures (ASRP): a comparison between neurological and non-neurological patients using the French National Health Data Base

Characterizing patients with multiple same-sided ureteric stones

Is tadalafil associated with decreased risk of major adverse cardiac events or venous thromboembolism in men with lower urinary tract symptoms?

Changes in overactive bladder medication following bariatric surgery: segmented regression analysis

The effect of prolonged laser activation on irrigation fluid temperature: an in vitro experimental study