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01-10-2017 | Original Article

Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc)

Authors: Malek Meskawi, Pierre-Alain Hueber, Roger Valdivieso, Franck Bruyere, Vincent Misrai, Georges Fournier, Ravi Munver, Ganesh Sivarajan, Matthew Rutman, Alexis E. Te, Bilal Chughtai, Dean Elterman, Tristan Martel, Mounsif Azizi, Pierre I. Karakiewicz, Kevin C. Zorn

Published in: World Journal of Urology | Issue 10/2017

Abstract

Purpose

To evaluate the outcomes and durability of photoselective vaporization of the prostate (PVP) using the XPS-180 system in patients with a large prostate volume (PV) > 100 cc at 4 years of follow-up in a large, multicenter experience.

Methods

438 men with pre-operative transrectal ultrasound (TRUS) PV > 100 cc were treated in eight experienced centers in Canada, USA, and in France with the Greenlight XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, postvoid residual (PVR), and prostate-specific antigen (PSA) were measured at 6, 12, 24, 36, and 48 months. Durability was evaluated using BPH retreatment rate at 12, 24, and 36 months.

Results

Median PV and PSA were 121 cc and 6.3 ng/dl. Indwelling catheter at the time of surgery was observed in 37% of men. Median operative, laser time, and energy applied were 90 min, 55 min, and 422 kJ, respectively. Median energy delivery was 3.4 kJ/cc of prostate per case. Outpatient surgery was feasible with median length of stay at 24 h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months. Moreover, surgical BPH retreatment rates were 5.4 and 9.3% at 24 and 36 months. Interestingly, characteristics of retreated men include: energy delivery 2.4 vs. 3.4 kJ/cc of prostate (p = 0.02) and PSA reduction at 12 months 26 vs. 51% (p = 0.02).

Conclusions

PVP using Greenlight XPS-180W can potentially provide durable improvements with regard to functional outcomes at 4 years. However, rising retreatment rates after 3 years is of concern. This highlights the imperative need of utilizing a standardized surgical technique (enucleation-like-defect) and an optimal energy density >3KJ/cc.

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Title: Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc)
Authors: Malek Meskawi
Pierre-Alain Hueber
Roger Valdivieso
Franck Bruyere
Vincent Misrai
Georges Fournier
Ravi Munver
Ganesh Sivarajan
Matthew Rutman
Alexis E. Te
Bilal Chughtai
Dean Elterman
Tristan Martel
Mounsif Azizi
Pierre I. Karakiewicz
Kevin C. Zorn
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 10/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-017-2007-7

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Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc)

Abstract

Purpose

Methods

Results

Conclusions

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Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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