5-year long-term efficacy of 120-W GreenLight photoselective vaporization of the prostate for benign prostate hyperplasia

Abstract

PurposeTo investigate 5-year long-term postoperative efficacy in benign prostate hyperplasia (BPH) following 120-W GreenLight high-performance system photoselective vaporization of the prostate (HPS-PVP)MethodsThis was a retrospective study of surgical outcomes in 159 men who underwent HPS-PVP and were followed over 60 months postoperatively. Definitions of treatment success were established based on the following three variables: international prostate symptom scores (IPSS), maximum flow rates (Qmax), and quality of life scores QoL). Logistic regression analyses were performed to determine predictors of the postoperative success.ResultsPostoperative IPSS/QoL, Qmax and post-voided residual urine volume were significantly improved after HPS-PVP. Postoperative Prostate specific antigen and prostate volume were also well reduced and sustained for 5 years. The postoperative success rate was assessed as 82.1%, 80.8% and 76.1% for each 1-, 3-, and 5-year. Thirty-eight (23.9%) patients had immediate postoperative complications, which were managed successfully with nonsurgical methods. None required transfusions, two (1.2%) patients required endoscopic reoperation for postoperative voiding difficulty due to bladder neck contracture or urethral stricture, and five (3.1%) required HPS-PVP reoperation. Presence of diabetes, voiding symptom subscore, QoL, maximal cystometric capacity, and bladder outlet obstructive index were valuable preoperative parameters for predicting postoperative success.ConclusionsHPS-PVP is an effective, long-term treatment option for BPH, with sustained efficacy of 76.1% at 5-year follow up. Several preoperative parameters could help to predict the durable surgical improvements.

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

“…Surgical treatment of BPE is indicated when pharmacological management is not satisfactory, symptoms have worsened or a complication such as refractory urinary retention, renal injury, urinary tract infection, bladder calculi or consistent prostatic bleeding, occurs …”

“…Taking into account that nowadays the life expectancy has increased, patients older are at a higher risk of BPE and other comorbidities that increase the risk of bleeding and complications during surgery. Thus, high‐risk patients have been excluded from most of the studies published …”

“…1,2 Surgical treatment of BPE is indicated when pharmacological management is not satisfactory, symptoms have worsened or a complication such as refractory urinary retention, renal injury, urinary tract infection, bladder calculi or consistent prostatic bleeding, occurs. 3,4 In the photovaporization of the prostate (PVP), GreenLight Laser with 532 nm, absorbs selectively the oxyhemoglobin promoting coagulation and cell disintegration, and inducing hemostasis. 5,6 The MoXy fiber used in the procedure, increases contact surface and makes more efficient the removal of the prostate.…”

“…Thus, high-risk patients have been excluded from most of the studies published. 4,6,11,12 The American Society of Anesthesiologists (ASA) Physical Status (ASAPS) classification categorize patients according to their comorbidities to predict operative risk. 13 ASA 1 is a patient with no comorbidities, ASA 2 is a patient with controlled comorbidities, ASA 3 is a patient with poor control of their comorbidities that are not life-threatening, and ASA 4 is a patient with uncontrolled comorbidities that are a constant threat to life.…”

Management of greenlight laser plus transurethral resection of prostate for elderly men

“…Additionally, another study found that HPS-PVP was an effective, long-term treatment option for BPH, with sustained efficacy of 76.1% at 5-year follow-up. [ 21 ] Consequently, it seems to be wise for older and high-risk BPH/LUTS men to receive a less invasive PVP operation.…”