Pierre-Alain Hueber1, Marc Nicolas Bienz1, Roger Valdivieso1, Hugo Lavigueur-Blouin1, Vincent Misrai2, Matthew Rutman3, Alexis E Te4, Bilal Chughtai4, Neil J Barber5, Amr M Emara5, Ravi Munver6, Quoc-Dien Trinh7, Kevin C Zorn8. 1. Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada. 2. Department of Urology, Clinique Pasteur Toulouse, Toulouse, France. 3. Department of Urology, Columbia University, New York, New York. 4. Department of Urology, Cornell University, New York, New York. 5. Department of Urology, Frimley Park Hospital, Frimley, United Kingdom. 6. Department of Urology, Hackensack University Medical Center, New Jersey. 7. Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 8. Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada. Electronic address: zorn.chumurology@gmail.com.
Abstract
PURPOSE: We evaluated photoselective vaporization of the prostate using the GreenLight™ XPS™ 180 W system for benign prostatic hyperplasia treatment in a large multi-institutional cohort at 2 years. We particularly examined safety, outcomes and the re-treatment rate in larger prostates, defined as a prostate volume of 80 cc or greater, to assess the potential of photoselective vaporization of the prostate as a size independent procedure. MATERIALS AND METHODS: A total of 1,196 patients were treated at 6 international centers in Canada, the United States, France and England. All parameters were collected retrospectively, including complications, I-PSS, maximum urinary flow rate, post-void residual urine, prostate volume, prostate specific antigen and the endoscopic re-intervention rate. Subgroup stratified comparative analysis was performed according to preoperative prostate volume less than 80 vs 80 cc or greater on transrectal ultrasound. RESULTS: Median prostate size was 50 cc in 387 patients and 108 cc in 741 in the prostate volume groups less than 80 and 80 cc or greater, respectively. The rate of conversion to transurethral prostate resection was significantly higher in the 80 cc or greater group than in the less than 80 cc group (8.4% vs 0.6%, p <0.01). I-PSS, quality of life score, maximum urinary flow rate and post-void residual urine were significantly improved compared to baseline at 6, 12 and 24 months of followup without significant differences between the prostate size groups. The re-treatment rate at 2 years reported in 5 of 411 patients was associated with the delivery of decreased energy density (2.1 vs 4.4 kJ/cc) in the group without re-treatment. CONCLUSIONS: Photoselective vaporization of the prostate using the XPS 180 W system is safe and efficacious, providing durable improvement in functional outcomes at 2 years independent of prostate size when treated with sufficient energy.
PURPOSE: We evaluated photoselective vaporization of the prostate using the GreenLight™ XPS™ 180 W system for benign prostatic hyperplasia treatment in a large multi-institutional cohort at 2 years. We particularly examined safety, outcomes and the re-treatment rate in larger prostates, defined as a prostate volume of 80 cc or greater, to assess the potential of photoselective vaporization of the prostate as a size independent procedure. MATERIALS AND METHODS: A total of 1,196 patients were treated at 6 international centers in Canada, the United States, France and England. All parameters were collected retrospectively, including complications, I-PSS, maximum urinary flow rate, post-void residual urine, prostate volume, prostate specific antigen and the endoscopic re-intervention rate. Subgroup stratified comparative analysis was performed according to preoperative prostate volume less than 80 vs 80 cc or greater on transrectal ultrasound. RESULTS: Median prostate size was 50 cc in 387 patients and 108 cc in 741 in the prostate volume groups less than 80 and 80 cc or greater, respectively. The rate of conversion to transurethral prostate resection was significantly higher in the 80 cc or greater group than in the less than 80 cc group (8.4% vs 0.6%, p <0.01). I-PSS, quality of life score, maximum urinary flow rate and post-void residual urine were significantly improved compared to baseline at 6, 12 and 24 months of followup without significant differences between the prostate size groups. The re-treatment rate at 2 years reported in 5 of 411 patients was associated with the delivery of decreased energy density (2.1 vs 4.4 kJ/cc) in the group without re-treatment. CONCLUSIONS: Photoselective vaporization of the prostate using the XPS 180 W system is safe and efficacious, providing durable improvement in functional outcomes at 2 years independent of prostate size when treated with sufficient energy.
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Authors: David-Dan Nguyen; Iman Sadri; Kyle Law; Naeem Bhojani; Dean S Elterman; Ahmed S Zakaria; Adel Arezki; 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 Journal: World J Urol Date: 2021-01-03 Impact factor: 4.226