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A Study of the Role of 180W XPS Lithium Triborate Laser in the Treatment of Patients With Lower Urinary Tracts Symptoms Due to Benign Prostatic Hyperplasia

Omar Salim Akhtar, Shailesh Raina
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Abstract

Introduction: Benign prostatic hyperplasia (BPH) is a disease of the prostate commonly seen in elderly males known to cause lower urinary tract symptoms (LUTS) that may require surgery as a part of treatment. Transurethral resection of the prostate (TURP) is considered the gold standard of surgical treatment, but it is not without complications. Laser photoselective vaporisation of the prostate (PVP), introduced in 1998 as an 80 W Nd:YAG laser which passed through a KTP (potassium-titanyl-phosphate) crystal, emerged as a safe alternative to TURP in selected cases. A recent upgrade to the Greenlight XPS 180 W powered with an LBO (lithium triborate) crystal has been available for use since 2012. Data on the use of this new upgrade is still being collected and analysed, especially in patients with large prostates or high risk cases. We analysed cases done at Jaslok Hospital over a 2-year period.
Methods: A total of 34 patients who underwent Laser PVP using XPS 180W for LUTS due to BPH at Jaslok Hospital were part of this study. We analysed the pre- and postoperative variables and the intraoperative parameters of all patients.
Results: The XPS 180W was found to be safe and efficacious. Eighteen patients were high-risk cases, classified as ASA (American Society of Anesthesiologists) Classes 3 and 4. Average postoperative catheter duration was 40.18 hours. In prostates of size <80 mL, an average of 229 kJ of energy was used. In large prostates (>80 mL), an average of 390 kJ of energy was used. No major complications were seen in any of the high-risk patients, classified as Clavien Dindo Class 3 and 4. The postoperative drop in IPSS (International Prostate Symptom Score) was 8.7.
Conclusion: We found that Green Light Laser XPS 180W may be used for large (>80 g) prostates, hitherto an indication for open surgery, and that it may be used in high-risk patients, who were otherwise unfit for TURP. It is safe and efficacious. Further, multicenter trials are required to confirm the findings.

Keywords

LUTS; BPH; GreenLight Laser; PVP; XPS 180W; Laser Prostatectomy

References

Chapple CR, Roehrborn CG. A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol. 2006;49(4):651-658. doi:10.1016/j. eururo.2006.02.018

Oelke M, Bachmann A, Descazeaud A, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64(1):118-140. doi:10.1016/j.eururo.2013.03.004

Reich O, Gratzke C, Bachmann A, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008;180(1):246-249. doi:10.1016/j.juro.2008.03.058

Kavanagh LE, Jack GS, Lawrentschuk N. Prevention and management of TURP-related hemorrhage. Nat Rev Urol. 2011;8(9):504-514. doi:10.1038/nrurol.2011.106

Malek RS, Barrett DM, Kuntzman RS. High-power potassium-titanyl-phosphate (KTP/532) laser vaporization prostatectomy: 24 hours later. Urology. 1998;51(2):254-256.

Zorn KC, Liberman D. GreenLight 180W XPS photovaporization of the prostate: how I do it. Can J Urol. 2011;18(5):5918-5926.

Campbell NA, Chung AS, Yoon PD, Thangasamy I, Woo HH. Early experience photoselective vaporisation of the prostate using the 180W lithium triborate and comparison with the 120W lithium triborate laser. Prostate Int. 2013;1(1):42-45. doi:10.12954/pi.12006

Bouabdallah Z, Kharbouchi A, Colau A, Cariou G. [Prostate laser photovaporisation in patients at high risk of bleeding]. Pan Afr Med J. 2013;16:2. doi:10.11604/ pamj.2013.16.2.2853

Ruszat R, Wyler S, Forster T, et al. Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol. 2007;51(4):1031-1038. doi:10.1016/j. eururo.2006.08.006

Eken A, Soyupak B, Acil M, Arpaci T, Akbas T. Safety, efficacy and outcomes of the new GreenLight XPS 180W laser system compared to the GreenLight HPS 120W system for the treatment of benign prostatic hyperplasia in a prospective nonrandomized single-centre study. Can Urol Assoc J. 2015;9(1-2):e56-60. doi:10.5489/ cuaj.2263

McVary KT, Roerhborn CG, Avins AL, et al. American Urological Association Guideline: Management of Benign Prostatic Hyperplasia. American Urological Association; 2010.

Muir G, Gomez Sancha F, Bachmann A, et al. Techniques and Training with GreenLight HPS 120-W Laser Therapy of the Prostate: Position Paper. Eur Urol Suppl. 2008;7(4):370-377. doi:10.1016/j.eursup.2008.01.012

Bachmann A, Tubaro A, Barber N, et al. A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study. J Urol. 2015;193(2):570-578. doi:10.1016/j.juro.2014.09.001

Bachmann A, Muir GH, Collins EJ, et al. 180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures. Eur Urol. 2012;61(3):600- 607. doi:10.1016/j.eururo.2011.11.041

Hueber PA, Liberman D, Ben-Zvi T, et al. 180 W vs 120 W lithium triborate photoselective vaporization of the prostate for benign prostatic hyperplasia: a global, multicenter comparative analysis of perioperative treatment parameters. Urology. 2013;82(5):1108-1113. doi:10.1016/j.urology.2013.03.059

Peyronnet B, Pradere B, Brichart N, Bodin T, Bertrand P, Bruyere F. Complications associated with photoselective vaporization of the prostate: categorization by a panel of GreenLight users according to Clavien score and report of a single-center experience. Urology. 2014;84(3):657- 664. doi:10.1016/j.urology.2014.05.028

Ben-Zvi T, Hueber PA, Liberman D, Valdivieso R, Zorn KC. GreenLight XPS 180W vs HPS 120W laser therapy for benign prostate hyperplasia: a prospective comparative analysis after 200 cases in a single-center study. Urology. 2013;81(4):853-858. doi:10.1016/j. urology.2012.12.031

West KE, Woo HH. Does prostate size impact upon perioperative outcomes associated with photoselective vaporization of the prostate using the 180W lithium triborate laser? Urol Ann. 2015;7(1):17-20. doi:10.4103/0974-7796.148579

Hueber PA, Bienz MN, Valdivieso R, et al. Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia Using the 180 Watt System: Multicenter Study of the Impact of Prostate Size on Safety and Outcomes. J Urol. 2015;194(2):462-469. doi:10.1016/j. juro.2015.03.113

Benejam-Gual JM, Sanz-Granda A, Budia A, Extramiana J, Capitan C. Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate. Actas Urol Esp. 2014;38(6):373-377. doi:10.1016/j. acuro.2013.10.011




DOI: https://doi.org/10.22037/jlms.v9i4.19461