To present outcomes of a simplified GreenLight laser enucleation of the prostate (GreenLEP) technique and to inform urologists considering incorporation of enucleation into their practice.
We reviewed all consecutive GreenLEPs by a single surgeon from 2015-2018.
Baseline patient characteristics, pre-enucleation prostate volume, enucleated adenoma weight, blood loss, lasering time and energy utilized were recorded. Primary outcomes were urinary flow rate (uroflow) and PVR. Secondary outcomes included international prostate symptom score (IPSS) and PSA change. Primary and secondary outcomes were measured up to 3 years and compared using Student's t-test. Adverse event and complication rates were recorded.
108 patients underwent GreenLEP with mean follow up of 10.2 months. Statistically significant improvements were noted at 3 months in Qmax (237%, p<0.01) and Qavg (227%, p<0.01), with changes remaining durable through 2 years. Statistically significant improvements were noted at 3 months in IPSS (-64%, p<0.01), PVR (-83%, p<0.01) and PSA change (-77%, p<0.01). Adverse event and complication rates were comparable to other published enucleation studies. Sexual activity was reported in 36% of patients, all of whom reported retrograde ejaculation. Patients experienced dysuria (6%), stress urinary incontinence (6%), urge urinary incontinence (16%), urethral stricture (6%), bladder perforation (n=2), prostatic capsular perforation (n=1) and ureteral injury (n=1).
Simplified GreenLEP shows effective and durable results with an acceptable adverse event and complication profile. This technique is optimal for novice enucleators familiar with photoselective vaporization.
Urology. 2019 Jun 21 [Epub ahead of print]
Petar Bajic, Nicolas Noriega, Alex Gorbonos, Edward Karpman
Department of Urology, Loyola University Stritch School of Medicine, 2160 S. First Ave, Maywood, IL, USA, 60153. Electronic address: ., El Camino Urology Medical Group, 2500 Grant Rd, Mountain View, CA, USA, 94040., Department of Urology, Loyola University Stritch School of Medicine, 2160 S. First Ave, Maywood, IL, USA, 60153.