Fady K Ghobrial, Mahmoud Laymon, Nasr El-Tabey, Ahmed M Elshal
{"title":"Greenlight laser (XPS-180watt) prostatectomy for treatment of benign prostate obstruction, Pursuit of durability.","authors":"Fady K Ghobrial, Mahmoud Laymon, Nasr El-Tabey, Ahmed M Elshal","doi":"10.1080/2090598X.2023.2220631","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPS<sup>TM</sup> system are still pending.</p><p><strong>Patients and methods: </strong>Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported.</p><p><strong>Results: </strong>Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, <i>P</i> = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (<i>P</i> = 0.03). In retreatment group, more intraoperative bleeding (<i>P</i> = 0.02), early postoperative hematuria (<i>P</i> = 0.03), higher median preoperative PSA (<i>P</i> = 0.02) and less postoperative one-year percent PSA reduction (<i>P</i> = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76).Median (range in months) time to event was 20 (1-60) for all cases and 13.5 (1-42) and 30 (18-60), <i>P</i> = 0.7, for GL.PVP and GL.PVEP groups, respectively.</p><p><strong>Conclusion: </strong>Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776041/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arab Journal of Urology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/2090598X.2023.2220631","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPSTM system are still pending.
Patients and methods: Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported.
Results: Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, P = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (P = 0.03). In retreatment group, more intraoperative bleeding (P = 0.02), early postoperative hematuria (P = 0.03), higher median preoperative PSA (P = 0.02) and less postoperative one-year percent PSA reduction (P = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76).Median (range in months) time to event was 20 (1-60) for all cases and 13.5 (1-42) and 30 (18-60), P = 0.7, for GL.PVP and GL.PVEP groups, respectively.
Conclusion: Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.
期刊介绍：
The Arab Journal of Urology is a peer-reviewed journal that strives to provide a high standard of research and clinical material to the widest possible urological community worldwide. The journal encompasses all aspects of urology including: urological oncology, urological reconstructive surgery, urodynamics, female urology, pediatric urology, endourology, transplantation, erectile dysfunction, and urinary infections and inflammations. The journal provides reviews, original articles, editorials, surgical techniques, cases reports and correspondence. Urologists, oncologists, pathologists, radiologists and scientists are invited to submit their contributions to make the Arab Journal of Urology a viable international forum for the practical, timely and state-of-the-art clinical urology and basic urological research.
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