David-Dan Nguyen1, Claudia Deyirmendjian2, Kyle Law3, Naeem Bhojani3, Dean S Elterman4, Bilal Chughtai5, Franck Bruyère6, Luca Cindolo7, Giovanni Ferrari7, Carlos Vasquez-Lastra8, Tiago Borelli-Bovo9, Edgardo F Becher10, Hannes Cash11,12, Maximillian Reimann13, Enrique Rijo14, Vincent Misrai15, Kevin C Zorn16. 1. Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada. 2. Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. 3. Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. 4. Division of Urology, University Health Network, Toronto, ON, Canada. 5. Department of Urology, Weill Cornell Medical College, New York, NY, USA. 6. Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France. 7. Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy. 8. Department of Urology, ABC Medical Center, Mexico City, Mexico. 9. Borelli Urologia, Ribeirão Presto, Sao Paulo, Brazil. 10. Centro de Urologia, CDU, Buenos Aires, Argentina. 11. Prouro, Urology Berlin, Berlin, Germany. 12. Department of Urology, University of Magdeburg, Magdeburg, Germany. 13. Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany. 14. Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain. 15. Department of Urology, Clinique Pasteur, Toulouse, France. 16. Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. zorn.chumurology@gmail.com.
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.
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.
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