GreenLight photovaporization of the prostate in high-medical-risk patients: An analysis of the Global GreenLight Group (GGG) database
Claudia Deyirmendjian1, David-Dan Nguyen2, Kyle Law3, Naeem Bhojani3, Dean Elterman4, Bilal Chughtai5, Franck Bruyère6, Luca Cindolo7, Giovanni Ferrari7, Carlos Vasquez-Lastra8, Tiago Borelli-Bovo9, Edgardo Becher10, Hannes Cash11, Maximilian Reimann12, Enrique Rijo13, Vincent Misrai14, Kevin Zorn3.
1Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 2Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; 3Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; 4Division of Urology, University Health Network, Toronto, ON, Canada; 5Division of Urology, Weill Cornell Medical College, New York, NY, United States; 6Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France; 7Division of Urology, Hesperia Hospital, Modena, Italy; 8Division of Urology, ABC Medical Center, Mexico City, , Mexico; 9Division of Urology, Ribeirão Presto, Sao Paulo, Brazil; 10Division of Urology, CDU, Buenos Aires, Argentina; 11Prouro, Urology, Berlin, Germany; 12Division of Urology, Charité – Universitaetsmedizin Berlin, Berlin, Germany; 13Division of Urology, Hospital Quiron Barcelona, Barcelona, Spain; 14Division of Urology, Clinique Pasteur, Toulouse, France
Introduction: Previous analyses of the safety and effectiveness of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients were limited by their small sample size and the ability to adjust for important confounders. We sought to characterize the adjusted outcomes of GreenLight PVP in HMR patients using data from the largest international database.
Methods: Data were obtained from the Global GreenLight Group (GGG) database, which pools data of eight high-volume, experienced surgeons from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. HMR patients were defined as patients with American Society of Anesthesiologists score of III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume.
Results: In the HMR group, patients, on average, were older and had smaller prostates than the non-HMR control group. Preoperatively, HMR patients had greater postvoid residual (PVR) and worse quality of life (QoL). Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p<0.01), and the odds of readmission were elevated (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4–2.8, p<0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group (+0.54, 95% CI 0.07–1.0, p=0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6–152.6, p<0.01). Prostate-specific antigen and maximal flow rate change did not differ significantly between both study arms.
Conclusions: We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.
