title: Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc).
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada.
authors.forename: Malek
authors.initials: M
authors.lastname: Meskawi
authors.affiliation: Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Hueber
authors.affiliation: Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Valdivieso
authors.affiliation: Department of Urology, CHU Tours, Tours, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyere
authors.affiliation: Department of Urology, Clinique Pasteur Toulouse, Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Misrai
authors.affiliation: Department of Urology, CHU Brest, Brest, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Fournier
authors.affiliation: Department of Urology, Hackensack University, Hackensack, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Munver
authors.affiliation: Department of Urology, Hackensack University, Hackensack, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Sivarajan
authors.affiliation: Department of Urology, Columbia University, New York City, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rutman
authors.affiliation: Department of Urology, Cornell University, New York City, USA.
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Te
authors.affiliation: Department of Urology, Cornell University, New York City, USA.
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.affiliation: Department of Urology, University of Toronto, Toronto, Canada.
authors.forename: Dean
authors.initials: D
authors.lastname: Elterman
authors.affiliation: Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada.
authors.forename: Tristan
authors.initials: T
authors.lastname: Martel
authors.affiliation: Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada.
authors.forename: Mounsif
authors.initials: M
authors.lastname: Azizi
authors.affiliation: Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada. zorn.chumurology@gmail.com.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology; D008297:Male; D009929:Organ Size; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011470:Prostatic Hyperplasia; D019233:Retreatment / Q000706:statistics & numerical data; D063189:Symptom Assessment; D014463:Ultrasonography / Q000379:methods; D014524:Urethral Obstruction / Q000175:diagnosis / Q000209:etiology
keywords: >100 cc; Benign prostate hyperplasia; Greenlight; Large prostate; Photoselective vaporization of the prostate; XPS