Multicenter International Experience of 532 nm-laser Photo-vaporization with Greenlight XPS in Men with Large Prostates (prostate Volume > 100 cc)

Overview

Journal World J Urol

Specialty Urology

Date 2017 Feb 24

PMID 28229211

Citations 19

Authors

Malek Meskawi

Pierre-Alain Hueber

Roger Valdivieso

Franck Bruyere

Vincent Misrai

Georges Fournier

Ravi Munver

Ganesh Sivarajan

Matthew Rutman

Alexis E Te

Bilal Chughtai

Dean Elterman

Tristan Martel

Mounsif Azizi

Pierre I Karakiewicz

Kevin C Zorn

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the outcomes and durability of photoselective vaporization of the prostate (PVP) using the XPS-180 system in patients with a large prostate volume (PV) > 100 cc at 4 years of follow-up in a large, multicenter experience.

Methods: 438 men with pre-operative transrectal ultrasound (TRUS) PV > 100 cc were treated in eight experienced centers in Canada, USA, and in France with the Greenlight XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, postvoid residual (PVR), and prostate-specific antigen (PSA) were measured at 6, 12, 24, 36, and 48 months. Durability was evaluated using BPH retreatment rate at 12, 24, and 36 months.

Results: Median PV and PSA were 121 cc and 6.3 ng/dl. Indwelling catheter at the time of surgery was observed in 37% of men. Median operative, laser time, and energy applied were 90 min, 55 min, and 422 kJ, respectively. Median energy delivery was 3.4 kJ/cc of prostate per case. Outpatient surgery was feasible with median length of stay at 24 h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months. Moreover, surgical BPH retreatment rates were 5.4 and 9.3% at 24 and 36 months. Interestingly, characteristics of retreated men include: energy delivery 2.4 vs. 3.4 kJ/cc of prostate (p = 0.02) and PSA reduction at 12 months 26 vs. 51% (p = 0.02).

Conclusions: PVP using Greenlight XPS-180W can potentially provide durable improvements with regard to functional outcomes at 4 years. However, rising retreatment rates after 3 years is of concern. This highlights the imperative need of utilizing a standardized surgical technique (enucleation-like-defect) and an optimal energy density >3KJ/cc.

Citing Articles

Comparative efficacy and safety of greenlight laser vaporization, anatomical vaporization, and enucleation for benign prostatic hyperplasia: a systematic review and meta-analysis.

Wang M, Chen S, Xi Y, Huang N, Zhang L, Liu J Lasers Med Sci. 2025; 40(1):139.

PMID: 40085272 DOI: 10.1007/s10103-025-04389-9.

Comparative efficacy and safety of 180 W XPS . 120 W HPS GreenLight laser therapy for benign prostatic hyperplasia: a systematic review and meta-analysis.

Wang M, Xi Y, Qiu Z, Huang N, Zhang L, Liu J PeerJ. 2024; 12:e18615.

PMID: 39619178 PMC: 11608016. DOI: 10.7717/peerj.18615.

WATER versus WATER II 5-year update: Comparing Aquablation therapy for benign prostatic hyperplasia in 30-80-cm and 80-150-cm prostates.

Berjaoui M, Nguyen D, Almousa S, Daher K, Barber N, Bidair M BJUI Compass. 2024; 5(11):1023-1033.

PMID: 39539565 PMC: 11557270. DOI: 10.1002/bco2.430.

Greenlight laser (XPS-180watt) prostatectomy for treatment of benign prostate obstruction, Pursuit of durability.

Ghobrial F, Laymon M, El-Tabey N, Elshal A Arab J Urol. 2024; 22(1):24-30.

PMID: 38205390 PMC: 10776041. DOI: 10.1080/2090598X.2023.2220631.

Reoperation after surgical treatment for benign prostatic hyperplasia: a systematic review.

He W, Ding T, Niu Z, Hao C, Li C, Xu Z Front Endocrinol (Lausanne). 2023; 14:1287212.

PMID: 38027158 PMC: 10665564. DOI: 10.3389/fendo.2023.1287212.

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