Open Access

ARTICLE

180W-LBO GreenLight XPS laser vaporization for benign prostatic hyperplasia: our experience with current markers of surgical proficiency for durable and reproducible outcomes

Joris Zhou^1,*, Côme Tholomier^1,*, Marc Zanaty¹, Pierre-Alain Hueber¹, Roger Valdivieso¹, Pierre Karakewicz¹, Daniel Liberman¹, Vincent Misrai², Kevin C. Zorn¹

1 CHUM Section of Urology, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
2 Department of Urology, Clinique Pasteur, Toulouse, France
* both authors contributed equally
Address correspondence to Dr. Kevin C. Zorn, CHUM, University of Montreal, 235 Rene Levesque East, Suite 301, Montreal, QC H2X 1B8 Canada

Canadian Journal of Urology 2017, 24(4), 8922-8931.

Abstract

Introduction: This study aims at analyzing the impact of reaching current markers of proficiency on intra and postoperative clinical outcomes of laser vaporization with 180W GreenLight XPS in the treatment of benign prostatic hyperplasia.
Materials and methods: A retrospective analysis was conducted on a prospectively collected database of 328 consecutive patients who underwent photoselective vaporization of the prostate (PVP) using Greenlight XPS performed by a single experienced laser surgeon. A logarithmic model was used to evaluate the case number to attain benchmark criteria for durable treatment. We compared clinical outcomes before and after current markers of proficiency, defined as either an energy density of 4kJ/cm³ or a 6 month prostate-specific antigen (PSA) drop of ≥ 50%, were attained.
Results: Energy delivered per prostate volume increased significantly with experience. The published benchmark values of 4kJ/cm³ and 6 month PSA drop of 50% were attained after 190 and 155 cases, respectively. There were no significant differences between groups in intraoperative complications or postoperative functional outcomes. However, the number of Clavien-Dindo category I adverse events significantly decreased with experience. Sub-analysis evaluating prostate volumes ≤ 80 cm³ and > 80 cm³ demonstrated comparable clinical outcomes before and after technical proficiency.
Conclusion: In our experience, the case volume required to achieve consistent reference values related to durable clinical outcomes and surgical proficiency was > 150 cases. However, desirable clinical outcomes were attained before reaching current markers of proficiency, regardless of preoperative prostate size. This suggests that current thresholds of technical proficiency may not be a good predictor of satisfying clinical outcomes.

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