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

Tholomier, Côme; Hueber, Pierre-Alain; Al‐Enizi, Abdullah M.; Valdivieso, Roger; Azizi, Mounsif; González, Ricardo R.; Eure, Gregg; Kriteman, Lewis; Hai, Mahmood A.; Zorn, Kevin C.

doi:10.1089/end.2016.0782

Cited by 21 publications

(16 citation statements)

References 28 publications

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“…Despite remaining on anticoagulation with aspirin while performing GL-XPS, it had no impact on morbidity or AEs, defined as the need of at least a pharmacological treatment (Clavien-Dindo >2) [15, 22, 23]. Postoperative acute urine retention as one major postoperative AE decreased over the 5 year study period and is in line with recently published results by Bachmann et al [7, 8].…”

Section: Discussionsupporting

confidence: 84%

Perioperative Changes and Progress in Photoselective Vaporization of the Prostate with GreenLight XPS 180 W System: A Single Center Experience

et al. 2018

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Purpose: The study aimed to evaluate progression of GreenLight-XPS 180 W photoselective vaporization of the prostate (GL-XPS) with respect to effectiveness, efficacy, and safety over time at a tertiary referral high volume center. Methods: The retrospective study included 375 men who underwent GL-XPS for symptomatic benign prostate obstruction (BPO) between June 2010 and February 2015. Primary outcome measurements were operation time (OT; min) and effective laser time (LT; min of OT) analyzed with regard to prostatic volume (PV; mL) (group 1 <40 mL up to 4 >80 mL in 20 mL steps) and the year of surgery (2010–2015). Results: The median age was 72 years (range 64–79), the median PV was 58 mL (range 33–98) and the median PV increased from 42 mL in 2012 to 80 mL in 2015. The OT and LT clearly correlated with the PV, being doubled for glands of median 95 mL compared to median 30 mL while the applied laser energy per LT likewise steadily increased. Overall, both OT and LT could be significantly reduced each year by 37% (OT; p < 0.05) and 36% (LT; p < 0.05) within 5 years. The hospital stay (days) and catheterization time (days) remained constant, without any changes over time. The overall complication rate (Clavien-Dindo >2) ranged from 36 to 15% between 2010 and 2015. The pre (median 22 + 4) and postoperative International Prostate Symptom Score-Quality of Life (median 5 + 1) showed a sufficient reduction in symptomatic BPO. Conclusion: GL-XPS is a safe and effective surgical method for symptomatic BPO. Our single center experience showed a significant improvement of both OT and effective LT within 5 years whilst maintaining stable low complication rate and high patient satisfaction.

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Section: Discussionsupporting

confidence: 84%

Perioperative Changes and Progress in Photoselective Vaporization of the Prostate with GreenLight XPS 180 W System: A Single Center Experience

et al. 2018

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“…Given the same irradiation time, the optimal VED could ablate more tissue due to high AR. In clinical situations, the typical size of large prostates for BPH treatment ranges from 80 to 120 cc [12]. Based upon the current findings, surgical urologists can remove 100 cc of prostate in around 34 min at the optimal VED while removing the same size in approximately 80 min at the maximal VED.…”

Section: Methodsmentioning

confidence: 63%

“…Table 2 summarizes three-level values of each parameter for ablation experiments. As clinical laser systems can deliver power levels ranging from 120 to 200 W, the three values (120, 160, and 200 W) were selected for P [12]. Based upon previous studies and clinical conditions, the three values for TS and BS were chosen, respectively [3,9,16].…”

Section: Methodsmentioning

confidence: 99%

“…Based upon the current findings, surgical urologists can remove 100 cc of prostate in around 34 min at the optimal VED while removing the same size in approximately 80 min at the maximal VED. However, it should be noted that the average clinical procedure for a 100 cc prostate gland takes around 120 min, which is 1.5~3.5 times long as the estimated procedure times [12]. One of the explanations could [18] be tissue component.…”

Section: Methodsmentioning

confidence: 99%

“…Thus, various surgical parameters, such as laser power, fiber size, working distance, and movement speed, are simultaneously regulated to achieve favorable clinical outcomes [3,10,11]. In particular, the laser power has recently been increased to treat large prostate glands (>80 cc) and eventually to reduce the procedure time [12]. However, the efficacy of the laser prostatectomy is still contingent upon the surgeon's skills, which needs more systematic approaches to optimize the surgical parameters and to attain more effective laser prostatectomy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Multivariate Analysis of Laser-Induced Tissue Ablation: Ex Vivo Liver Testing

Park

Kang

2017

Applied Sciences

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A number of laser parameters are often regulated to enhance ablation efficiency during laser surgery. As one of clinical treatments, laser removal of benign prostate hyperplasia has been well accepted by surgical urologists. However, due to complex interactions of the surgical parameters, the procedure is still lengthy and dependent upon the surgeon's skill and experience. The aim of the current study is to evaluate the feasibility of response surface method (RSM) to comprehend ablative interactions of multi-parameters and to identify the optimal ablation rate (AR). As a surrogate model in the feasibility study, bovine liver tissue was utilized for ex vivo ablation testing. Three laser parameters pertinent to laser prostatectomy were selected: power (P), treatment speed (TS), and beam spot (BS). As a three-level fractional factorial RSM, Box Behnken design (BBD) was employed to identify the range of each parameter for achieving the optimal AR. The results showed that regardless of TS, AR was linearly contingent on both P and BS due to high irradiance. TS of 6~7 mm/s induced the maximal AR when P of 180 W and BS of 0.4 mm 2 . The corresponding volumetric density energy yielded an ablation volume of 80 mm 2 , which was close to a transition to volumetric saturation. The BBD-based model showed a good agreement with the experimental data in terms of ablation volume. The proposed multivariate parametric analysis can be an efficient design method to identify the optimal conditions for laser therapeutics. Further investigations will be performed on prostatic tissue to validate the proposed approach and to explore various optimization processes.

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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

Barco‐Castillo

Zuluaga

Santander

et al. 2019

Neurourology and Urodynamics

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Aims: Photovaporization of the prostate (PVP) with GreenLight Laser is a surgical treatment for lower urinary tract symptoms. It is considered safe in elderly patients with comorbidities, however, the evidence is inconclusive. The objective of this study is to evaluate the efficacy and safety outcomes of PVP according to the American Society of Anesthesiologists Physical Status (ASAPS). Methods: A cohort of 675 patients who underwent PVP between 2012 and 2018 was evaluated. Patients were classified according to their ASAPS as low (I and II) and high risk (III and IV). Surgical characteristics and improvement of symptoms and Quality of Life (QoL) were evaluated.Results: The median age of high-risk group was higher than low-risk group. The high-risk group had more history of anticoagulation, antiaggregation, urinary catheterization, urinary retention and urethral stricture. Longer times of hospitalization ] vs 21.8 hours , P = .008) and catheterization .57] vs 17.67 hours [IQR = 14.76-22.5], P = .004) were found in the high-risk group. Conversion and bleeding control were not different between groups. In the follow-up

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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

Cited by 21 publications

References 28 publications

Perioperative Changes and Progress in Photoselective Vaporization of the Prostate with GreenLight XPS 180 W System: A Single Center Experience

Perioperative Changes and Progress in Photoselective Vaporization of the Prostate with GreenLight XPS 180 W System: A Single Center Experience

Multivariate Analysis of Laser-Induced Tissue Ablation: Ex Vivo Liver Testing

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

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