Open Access

ARTICLE

Mid term outcomes of initial 250 case experience with GreenLight 120W-HPS photoselective vaporization prostatectomy for benign prostatic hyperplasia: comparison of prostate volumes < 60 cc, 60 cc-100 cc and > 100 cc

Pierre-Alain Hueber¹, Tal Ben-Zvi¹, Daniel Liberman¹, Naeem Bhojani¹, Gagan Gautam², Tom Deklaj², Mark Katz², Kevin C. Zorn^1,2

1 Section of Urology Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
2 Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois, USA
Address correspondence to Dr. Kevin C. Zorn MD, University of Montreal Health Center (CHUM), 235 René-Levesque Blvd. East, Suite 301,Montreal, QC H2X 1N8 Canada

Canadian Journal of Urology 2012, 19(5), 6450-6458.

Abstract

Introduction: The aim of this study was to compare the efficacy of GreenLight 120-HPS (American Medical Systems, Minnetonka, Minnesota, USA) laser vaporization for men with obstructive benign prostatic hyperplasia (BPH) according to prostate volumes: <60 cc, 60–100 cc, and >100 cc.
Material and methods: The clinical data of 250 men with symptomatic BPH who underwent photoselective vaporization prostatectomy (PVP) by a single surgeon between July 2007 and August 2009 were retrospectively analyzed. Prostate volumes were measured by transrectal ultrasonography (TRUS). Functional evaluations were performed at 3, 6, and 12 months, with prostate-specific antigen (PSA) levels obtained at 6 months. All men were stratified into three groups according to TRUS volume.
Results: Among the 250 consecutive PVP patients, 134, 76, and 40 men had prostate volumes <60 cc, 60–100 cc, and >100 cc, respectively. Mean laser time and delivered energy were 31, 44, and 59 minutes; and 163, 309, and 473 kJ, respectively (p < 0.01 for all). At one year, mean International Prostate Symptom Score (IPSS) improved by 69%, 63%, and 50%; Qmax increased by 194%, 175%, and 162%; and post-void residual (PVR) decreased by 88%, 81%, and 71%, respectively (p < 0.01 for all). Mean decrease in preoperative PSA at 6 months was 63%, 52%, and 41%, respectively (p < 0.01). Hospital stay, catheterization time, and complication rates were comparable between groups. However, retreatment rates were significantly higher for prostates >100 cc (1.5% vs. 2.6% vs. 9%; p = 0.02).
Conclusions: Although larger prostates require more time and energy delivery, PVP is safe and efficacious for patients with lower urinary tract symptoms (LUTS) regardless of prostate size. Laser vaporization for glands >100 cc appears to have a reduced reduction in PSA and a higher 9% rate of retreatment, indicating that PVP for larger prostates remains to be optimized.

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