Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc).

Autor: Meskawi M; Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada., Hueber PA; Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada., Valdivieso R; Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada., Bruyere F; Department of Urology, CHU Tours, Tours, France., Misrai V; Department of Urology, Clinique Pasteur Toulouse, Toulouse, France., Fournier G; Department of Urology, CHU Brest, Brest, France., Munver R; Department of Urology, Hackensack University, Hackensack, USA., Sivarajan G; Department of Urology, Hackensack University, Hackensack, USA., Rutman M; Department of Urology, Columbia University, New York City, USA., Te AE; Department of Urology, Cornell University, New York City, USA., Chughtai B; Department of Urology, Cornell University, New York City, USA., Elterman D; Department of Urology, University of Toronto, Toronto, Canada., Martel T; Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada., Azizi M; Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada., Karakiewicz PI; Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada., Zorn KC; Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada. zorn.chumurology@gmail.com.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2017 Oct; Vol. 35 (10), pp. 1603-1609. Date of Electronic Publication: 2017 Feb 22.
DOI: 10.1007/s00345-017-2007-7
Abstrakt: Purpose: To evaluate the outcomes and durability of photoselective vaporization of the prostate (PVP) using the XPS-180 system in patients with a large prostate volume (PV) > 100 cc at 4 years of follow-up in a large, multicenter experience.
Methods: 438 men with pre-operative transrectal ultrasound (TRUS) PV > 100 cc were treated in eight experienced centers in Canada, USA, and in France with the Greenlight XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, postvoid residual (PVR), and prostate-specific antigen (PSA) were measured at 6, 12, 24, 36, and 48 months. Durability was evaluated using BPH retreatment rate at 12, 24, and 36 months.
Results: Median PV and PSA were 121 cc and 6.3 ng/dl. Indwelling catheter at the time of surgery was observed in 37% of men. Median operative, laser time, and energy applied were 90 min, 55 min, and 422 kJ, respectively. Median energy delivery was 3.4 kJ/cc of prostate per case. Outpatient surgery was feasible with median length of stay at 24 h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months. Moreover, surgical BPH retreatment rates were 5.4 and 9.3% at 24 and 36 months. Interestingly, characteristics of retreated men include: energy delivery 2.4 vs. 3.4 kJ/cc of prostate (p = 0.02) and PSA reduction at 12 months 26 vs. 51% (p = 0.02).
Conclusions: PVP using Greenlight XPS-180W can potentially provide durable improvements with regard to functional outcomes at 4 years. However, rising retreatment rates after 3 years is of concern. This highlights the imperative need of utilizing a standardized surgical technique (enucleation-like-defect) and an optimal energy density >3KJ/cc.
Databáze: MEDLINE
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