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Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database

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Abstract

Objectives

Previous analyses of the impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180 W XPS GreenLight PVP using a large international database.

Methods

Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score.

Results

A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22–10.23; p < 0.01) minutes and 2.90 (95% CI 1.02–4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11–3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6 months which was 46.51 ml (95% CI 4.65–88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes.

Conclusions

Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.

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Funding

None.

Author information

Author notes

  1. David-Dan Nguyen and Iman Sadri contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine, McGill University, Montreal, QC, Canada

    David-Dan Nguyen, Iman Sadri, Kyle Law & Adel Arezki

  2. Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada

    Naeem Bhojani, Ahmed S. Zakaria & Kevin C. Zorn

  3. Division of Urology, University Health Network, Toronto, ON, Canada

    Dean S. Elterman

  4. Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Tours, Centre-Val de Loire, France

    Franck Bruyère

  5. Department of Urology, Hesperia Hospital, Modena, Italy

    Luca Cindolo & Giovanni Ferrari

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

    Carlos Vasquez-Lastra

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

    Tiago Borelli-Bovo

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

    Edgardo F. Becher

  9. Department of Urology, Charite–Universitaetsmedizin Berlin, Berlin, Germany

    Hannes Cash & Maximillian Reimann

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

    Enrique Rijo

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

    Vincent Misrai

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  1. David-Dan Nguyen
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Contributions

DDN protocol/project development, data collection or management, data analysis, manuscript writing/editing. IS protocol/project development, data collection or management, data analysis, manuscript writing/editing. KL protocol/project development, data collection or management, manuscript writing/editing. NB protocol/project development, manuscript writing/editing. DSE: Protocol/project development, manuscript writing/editing. ASZ protocol/project development, manuscript writing/editing. AA protocol/project development, manuscript writing/editing. FB Protocol/project development, manuscript writing/editing. LC protocol/project development, manuscript writing/editing. GF protocol/project development, manuscript writing/editing. CVL protocol/project development, manuscript writing/editing. TBB protocol/project development, manuscript writing/editing. EFB protocol/project development, manuscript writing/editing. HC protocol/project development, manuscript writing/editing. MR protocol/project development, manuscript writing/editing. ER protocol/project development, manuscript writing/editing. VM protocol/project development, manuscript writing/editing. KCZ protocol/project development, data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Kevin C. Zorn.

Ethics declarations

Conflict of interest

Consultants and proctors for Boston Scientific for greenlight: KZ, DSE, VM, ER, HC. 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.

Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required (retrospective study).

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Nguyen, DD., Sadri, I., Law, K. et al. Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database. World J Urol 39, 3881–3889 (2021). https://doi.org/10.1007/s00345-020-03529-w

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