Predictors of re-intervention after greenlight laser photoselective vaporization of the prostate: multicenter long/mid-term follow-up experience

Abstract

Aim: Greenlight photoselective vaporization of the prostate (PVP) is considered a safe alternative to transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms (LUTS) and a prostate volume of 30-80 mL for the comparable short- and mid-term results. Long-term re-treatment rate is still being debated.

Methods: We retrospectively reviewed greenlight PVP procedures in a multi-institutional database from September 2011 to December 2019 collecting data on patients requiring re-intervention with a follow-up period of at least 12 months.

Results: Among 867 patients with a median follow-up period of 32.5 months (interquartile range: 20.0-49.0 months), 35 patients (4%) required re-intervention. Patients requiring re-intervention had a prostate volume ≥ 100 mL in 28.6% of cases (P = 0.002). Preoperative urethral stricture and incidence of early complications were more frequent in the re-treatment group (P = 0.027 and P = 0.006). In the re-treatment group, 22 patients required an endoscopic intervention for bladder neck or prostatic fossa contracture (2.5% of the study population). The remaining 13 patients in the re-treatment group underwent TURP or PVP for LUTS relapse (1.5%). In the univariate and multivariate logistic regression models, only prostate volume ≥ 100 mL (P = 0.003 and P = 0.010), preoperative urethral stricture (P = 0.013 and P = 0.036), and occurrence of early complications (P = 0.008 and P = 0.024) correlated with re-intervention.

Conclusion: Greenlight PVP has good functional long/mid-term results. The presence of preoperative urethral stricture and the occurrence of early complications correlate with the risk of late re-treatment. In patients with prostate ≥ 100 mL, the enucleation technique may be superior to vaporization in terms of lower long-term risk of re-intervention for LUTS relapse.

Keywords

Greenlight laser / long-term results / re-intervention

References

[1] Lieber MM,Jacobson DJ.Natural history of benign prostatic enlargement: long-term longitudinal population-based study of prostate volume doubling times.BJU Int2010;105:214-9 PMCID:PMC2862564

[2] Gravas S,Gacci M.EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. Benign prostatic obstruction (BPO). Netherlands: European Association of Urology; 2015.

[3] Cindolo L,Fanizza C.Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study.Eur Urol2015;68:418-25

[4] Falavolti C,Buscarini M.Robot-assisted simple prostatectomy with temporary internal iliac arteries clamping: our preliminary results.Mini-invasive Surg2017;1:35-40

[5] Gu C,Gurung P.Lasers versus bipolar technology in the transurethral treatment of benign prostatic enlargement: a systematic review and meta-analysis of comparative studies.World J Urol2020;38:907-18

[6] Campobasso D,Frattini A.Greenlight laser: a laser for every prostate and every urologist.World J Urol2020;

[7] Cindolo L,Destefanis P,Ferrari G.Vaporize, anatomically vaporize or enucleate the prostate?.Int Urol Nephrol2017;49:405-11

[8] Law KW,Nguyen DD.Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety.World J Urol2021;

[9] Meskawi M,Valdivieso R.Complications and functional outcomes of high-risk patient with cardiovascular disease on antithrombotic medication treated with the 532-nm-laser photo-vaporization Greenlight XPS-180 W for benign prostate hyperplasia.World J Urol2019;37:1671-8

[10] Campobasso D,Altieri V.GreenLight photoselective vaporization of the prostate: one laser for different prostate sizes.J Endourol2020;34:54-62

[11] Leonardo C,Cindolo L.AGILE GroupWhat is the standard surgical approach to large volume BPE?.Minerva Urol Nefrol2020;72:22-9

[12] De Nunzio C,Autorino R.Contemporary monopolar and bipolar transurethral resection of the prostate: prospective assessment of complications using the Clavien system.Int Urol Nephrol2013;45:951-9

[13] Mamoulakis C,Kazoulis S,Sofras F.The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate.World J Urol2011;29:205-10 PMCID:PMC3062770

[14] Hossack T.Validation of a patient reported outcome questionnaire for assessing success of endoscopic prostatectomy.Prostate Int2014;2:182-7 PMCID:PMC4286730

[15] Thomas JA,Barber N.A multicenter randomized noninferiority trial comparing greenlight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study.Eur Urol2016;69:94-102

[16] Ajib K,Zanaty M.Photoselective vaporization of the prostate with the 180-W XPS-Greenlight laser: five-year experience of safety, efficiency, and functional outcomes.Can Urol Assoc J2018;12:E318-24 PMCID:PMC6118054

[17] Cindolo L,Greco F.Members of Green Laser Italian GroupStandard vs. anatomical 180-W GreenLight laser photoselective vaporization of the prostate: a propensity score analysis.World J Urol2018;36:91-7

[18] Campobasso D,De Nunzio C.Post-operative acute urinary retention after greenlight laser. Analysis of risk factors from a multicentric database.Urol J2021;

[19] Laine-Caroff P,Ruffion A.Greenlight laser photoselective vaporization vs open simple prostatectomy: long-term functional outcomes after treatment of large volume prostates (> 80 cc).Int Urol Nephrol2021;53:1289-95

[20] Meskawi M,Valdivieso R.Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc).World J Urol2017;35:1603-9

[21] Valdivieso R,Meskawi M.Multicentre international experience of 532-nm laser photoselective vaporization with GreenLight XPS in men with very large prostates.BJU Int2018;122:873-8

[22] Stone BV,Forde JC,Lewicki P.Safety and efficacy of GreenLight XPS laser vapoenucleation in prostates measuring over 150 mL.J Endourol2016;30:906-12

[23] Hueber PA,Valdivieso R.Photoselective vaporization of the prostate for benign prostatic hyperplasia using the 180 Watt system: multicenter study of the impact of prostate size on safety and outcomes.J Urol2015;194:462-9

[24] Altay B,Kiremit MC,Boz MY.180-W XPS GreenLight laser vaporization for benign prostate hyperplasia: 12-month safety and efficacy results for glands larger than 80 mL.Lasers Med Sci2015;30:317-23

[25] Kim A,Choi WS,Kim HG.Comparison of long-term effect and complications between holmium laser enucleation and transurethral resection of prostate: nations-wide health insurance study.Urology2021;154:300-7

[26] Elshal AM,El-Tabey NA,Nabeeh A.Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo-enucleation of the prostate for treatment of large benign prostate obstruction: 3-years outcomes.BJU Int2020;126:731-8

[27] Ferrari G,Gatti L.Green Light laser enucleation of the prostate with early apical release is safe and effective: single center experience and revision of the literature.Minerva Urol Nephrol2021;