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Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database

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Abstract

Introduction

GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80 cc) vs. small prostates (< 80 cc).

Methods

Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe.

Results

3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI 18.46–19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12 months (p = 0.005). There were no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28).

Conclusions

Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80 cc, with durable outcomes relatively independent from prostate size.

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Author notes

  1. Nicholas Corsi and David-Dan Nguyen denotes equal contribution.

Authors and Affiliations

  1. Wayne State University School of Medicine, Detroit, Michigan, USA

    Nicholas Corsi

  2. Division of Urology, University of Toronto, Toronto, ON, Canada

    David-Dan Nguyen & Dean S. Elterman

  3. Division of Urology, McGill University, Montreal, QC, Canada

    Adel Arezki & Iman Sadri

  4. Division of Urology, Université de Montréal, Montreal, QC, Canada

    Kyle Law, Claudia Deyirmendjian, Naeem Bhojani & Kevin C. Zorn

  5. Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada

    David Bouhadana

  6. Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Tours, France

    Franck Bruyère

  7. Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy

    Luca Cindolo & Giovanni Ferrari

  8. Department of Urology, ABC Medical Center, Mexico City, Mexico

    Carlos Vasquez-Lastra

  9. Borelli Urologia, Ribeirão Presto, Sao Paulo, Brazil

    Tiago Borelli-Bovo

  10. Centro de Urologia, CDU, Buenos Aires, Argentina

    Edgardo F. Becher

  11. Department of Urology, University of Magdeburg, Madeburg, Germany

    Hannes Cash

  12. Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany

    Maximillian Reimann

  13. Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain

    Enrique Rijo

  14. Department of Urology, Clinique Pasteur, Toulouse, France

    Vincent Misrai

  15. Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, USA

    Bilal Chughtai

Authors
  1. Nicholas Corsi
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Contributions

NC: Protocol/Project Development, Data Collection or Management, Manuscript Writing and Editing. DDN: Protocol/Project Development, Data Collection or Management, Data Analysis, Manuscript Writing and Editing. AA: Protocol/Project Development, Data Collection or Management, Data Analysis, Manuscript Writing and Editing. IS: Protocol/Project Development, Data Collection or Management, Data Analysis, Manuscript Writing and Editing. KL: Protocol/Project Development, Data Collection or Management, Data Analysis, Manuscript Writing and Editing. DB: Protocol/Project Development, Data Collection or Management, Data Analysis, Manuscript Writing and Editing. CD: Protocol/Project Development, Data Collection or Management, Data Analysis, Manuscript Writing and Editing. NB: Data Collection or Management, Manuscript Writing and Editing. DSE: Data Collection or Management, Manuscript Writing and Editing. FB: Data Collection or Management, Manuscript Writing and Editing. LC: Data Collection or Management, Manuscript Writing and Editing. GF: Data Collection or Management, Manuscript Writing and Editing. CVL: Data Collection or Management, Manuscript Writing and Editing. TBB: Data Collection or Management, Manuscript Writing and Editing. EFB: Data Collection or Management, Manuscript Writing and Editing. HC: Data Collection or Management, Manuscript Writing and Editing. MR: Data Collection or Management, Manuscript Writing and Editing. ER: Data Collection or Management, Manuscript Writing and Editing. VM: Data Collection or Management, Manuscript Writing and Editing. BC: Data Collection or Management, Manuscript Writing and Editing. KCZ: Protocol/Project Development, Data Collection or Management, Data Analysis, Manuscript Writing and Editing.

Corresponding author

Correspondence to Kevin C. Zorn.

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Conflict of interest

Consultants and proctors for Boston Scientific for greenlight: KZ, DSE, VM, ER, HC, EFB, BC. Investigators and consultants for PROCEPT BioRobotics: VM, TB, NB, KZ. Surgical tutors for Greenlight Xcelerated Performance System (American Medical System-AMS, Minnetonka, MN) and received honoraria for their tutorship: GF, LC. All other authors do not report any relevant conflicts of interest.

Data availability

The datasets generated during and/or analyzed during the current study are readily available from the corresponding author upon request.

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Corsi, N., Nguyen, DD., Arezki, A. et al. Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database. World J Urol 41, 529–536 (2023). https://doi.org/10.1007/s00345-022-04260-4

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