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Assessment of the learning curves for photoselective vaporization of the prostate using GreenLight™ 180-Watt-XPS laser therapy: defining the intra-operative parameters within a prospective cohort

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Abstract

Purpose

To assess the learning curves for the intra-operative parameters of the GreenLight™ 180-W XPS for photoselective vaporization of the prostate (PVP).

Methods

A prospective study was conducted on 200 men who underwent PVP using the GreenLight™ 180-W XPS over 20 months. The population was divided into four consecutive equal groups. Evolution of lasing parameters was the main endpoint to reach an average energy of 5 kJ per prostate volume and to reach a lasing time/operative time (LT/OT) ratio of 66–80 %. Changes in the IPSS and prostate volume were also evaluated 12 weeks later.

Results

Total energy delivered (energy/ml of prostate) and the LT/OT ratio significantly increased over time (p < 0.05). Urinary function significantly improved from baseline in all groups. The first lasing parameter endpoint was reached after the 75th patient (group 1) and the second endpoint (LT/OT ratio) after the 125th patient (group 3). Only the PSA level (p = 0.04) and prostate volume (p < 0.0001) decreased significantly in the 3rd and the 4th group. Post-operative complications occurred in 20 % of patients, which were primarily Clavien–Dindo grades 1 and 2, though there were no statistical differences between the four groups (p = 0.62). In-hospital stay and time to catheter removal were significantly shorter in the 3rd and 4th group.

Conclusions

The current study assessed the PVP learning curves within multiple intra-operative parameters. The PVP learning curves required at least 120 procedures until it met all intra-operative parameters of experts in this field.

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Authors and Affiliations

  1. Urology Department, Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France

    Vincent Misraï, Julien Guillotreau & Benoit Bordier

  2. Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Université Paris Sud, Villejuif, France

    Matthieu Faron

  3. Radiology Department, Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France

    Eric Bruguière

  4. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  5. AP-HP, Hopital Pitié-Salpétrière, Service d’Urologie, 75013, Paris, France

    Morgan Rouprêt

  6. UPMC Univ. Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, 75005, Paris, France

    Morgan Rouprêt

  7. AP-HP, Pitié Salpétrière, 83 Bvd Hopital, 75013, Paris, France

    Morgan Rouprêt

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  1. Vincent Misraï
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  2. Matthieu Faron
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Correspondence to Vincent Misraï.

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Misraï, V., Faron, M., Guillotreau, J. et al. Assessment of the learning curves for photoselective vaporization of the prostate using GreenLight™ 180-Watt-XPS laser therapy: defining the intra-operative parameters within a prospective cohort. World J Urol 32, 539–544 (2014). https://doi.org/10.1007/s00345-013-1163-7

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  • DOI: https://doi.org/10.1007/s00345-013-1163-7

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