@Article{,
AUTHOR = {Kevin C. Zorn, Daniel Liberman},
TITLE = {GreenLight 180W XPS photovaporization of the prostate: how I do it},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {18},
YEAR = {2011},
NUMBER = {5},
PAGES = {5918--5926},
URL = {http://www.techscience.com/CJU/v18n5/61884},
ISSN = {1488-5581},
ABSTRACT = {Transurethral resection of the prostate (TURP) is the
most common surgical intervention for benign prostatic
hyperplasia (BPH), largely due to lower urinary tract
symptoms refractory to medical therapy. TURP remains
the gold standard for men with prostates sized 30g-80g,
while open prostatectomy has been the preferred option
for men with glands larger than 80g-100 g and those
with other lower urinary tract anomalies such as large
bladder stones or bladder diverticula. Unfortunately, these
procedures have complications including bleeding (often
requiring transfusion in 7%-13% of cases), electrolyte
abnormalities (2% TURP syndrome), erectile dysfunction
(6%-10%), and retrograde ejaculation (50%-75%). The
overall incidence of a second intervention (repeat TURP,
urethrotomy and bladder neck incision) has been reported
in 12% and 15% of men at 5 and 10 years following TURP.
Alternative therapies have been developed with the aim
of reducing the level of complications while maintaining
effi cacy. These include microwave therapy, transurethral
needle ablation, and a range of laser procedures (Holmium,
Diode, Thulium and 532nm-Greenlight).
Photoselective vaporization of the prostate (PVP), initially
launched as a 60W prototype, was ultimately introduced
to the urology community as a 80W system (American
Medical Systems, Minnetonka, Minnesota, USA), has
been the predominant device used in clinical trials. This
1st generation used an Nd:YAG laser beam passed through
a potassium-titanyl-phosphate (KTP) crystal, halving the
wavelength (to 532nm), doubling the laser’s frequency, and
resulting in a green light. Outcomes have demonstrated a
reduced frequency and severity of clinical complications,
however it was limited to smaller prostate sizes. In 2006,
the 120W lithium triborate laser (LBO), also known as the
GreenLight HPS (High Performance System) laser was
introduced. This laser utilizes a diode pumped Nd:YAG
laser light that is emitted through an LBO instead of a KTP
crystal, resulting in a higher-powered 532 nm wavelength
green light laser while still using the same 70-degree
defl ecting, side fi ring, silica fi ber delivery system. The HPS
offered an 88% more collimated beam and smaller spot size,
resulting in much higher irradiance or power density in
its 2 predecessors (60W and 80W) with a beam divergence
of 8 versus 15 degrees. The primary aim for this upgrade
was to reduce lasing time and improve clinical outcomes
while demonstrating the same degree of safety for patients.
Limitations of the 120W system included treatment of
large prostates greater than 80g-100g and increased cost
related to fi ber devitrifi cation and fracture. In 2011, the
180W-Greenlight XPS system was introduced, not only
with increased power setting to vaporize tissue quicker
but signifi cant fi ber-design changes. Internal cooling,
metal-tip cap protection and FiberLife (temperature sensing
feedback), better preserve the integrity of the fi ber generally
producing a 1-fi ber per case expectation. Initial personal
experience with XPS has provided comparable outcomes
related to morbidity, but with the opportunity to perform
a more complete and rapid procedure. Published clinical
data with the XPS is unfortunately lacking.
The objective of this report is to detail our approach and
technique for GreenLight XPS drawing on personal
experience with both enucleation and vaporization
techniques with various laser technologies along with
having performed over 500 GreenLight HPS and 100 XPS
procedures. In this regard, recommendations for training
are also made, which relate to existing users of the 80W and
120W GreenLight laser as well as to new laser users.},
DOI = {}
}