Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with extremely large prostates (prostate volume > 200 cc).

According to EAU and AUA guidelines on management of male non-neurogenic lower urinary tract symptoms (LUTS), PVP XPS is superior to TURP with regard to intra-operative safety and postoperative complication rates such as bleeding. The experience of the GL system with very large glands (>200mL) is very limited. In the present study, we aimed to describe perioperative results as well as functional outcomes and complications of photo-vaporization of prostate glands bigger than 200 mL using the GL system.

Retrospective analysis of prospectively maintained multi center database was performed to select subgroup of men having very large prostates (>200mL) treated with the Greenlight-XPS laser. A subgroup of patients with prostate volumes 100-200mL was used as comparison. IPSS, Qmax, PVR and PSA were measured at 6, 12, 24, 36 and 48 months. Durability was evaluated using BPH re-treatment rate at 12, 24 and 36 months. Additionally complications were recorded using the Clavien- Dindo classification.

A total of 33 (38%) men had prostates larger than 200mL. Baseline characteristics were comparable between patients with glands >200mL and those with glands 100-200mL. Patients with very large prostates had longer OR times (129 vs 93 min), less energy delivered, a higher number of fibres used (3 vs 2) and a higher conversion to TURP (16 vs 4%). In terms of complications and functional outcomes, we did not find any differences among the groups. Retreatment rate was also comparable.

PVP Greenlight XPS-180W is an acceptable technique for very large prostates (>200mL). However, OR times, energy delivery, fibers used and conversion to TURP are a concern in this particular subgroup. This should be used for patient counselling and surgery planning. This article is protected by copyright. All rights reserved.

BJU international. 2018 Mar 23 [Epub ahead of print]

Roger Valdivieso, Pierre-Alain Hueber, Malek Meskawi, Eric Belleville, Khaled Ajib, Franck Bruyere, Alexis E Te, Bilal Chughtai, Dean Elterman, Vincent Misrai, Kevin C Zorn

Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Québec, Canada., Department of Urology, CHU Tours, France., Department of Urology, Cornell University, New York, NY, USA., Department of Urology, University of Toronto, Canada., Department of Urology, Clinique Pasteur, France.