Safety and efficacy of GreenLight photoselective vaporization of the prostate in octogenarians using the Global GreenLight Group database
Claudia Deyirmendjian1, David-Dan Nguyen2, David Bouhadana2, Kyle Law3, Naeem Bhojani3, Dean Elterman4, Bilal Chughtai5, Franck Bruyère6, Luca Cindolo7, Giovanni Ferrari7, Carlos Vasquez-Lastra8, Tiago Borelli-Bovo9, Edgardo F 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; 5Department 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; 7Department of Urology, Hesperia Hospital, Modena, Italy; 8Department of Urology, ABC Medical Center, Mexico City, , Mexico; 9Department of Urology, Ribeirão Presto, Sao Paulo, Brazil; 10Centro de Urologia, CDU, Buenos Aires, Argentina; 11Prouro, Urology, Berlin, Germany; 12Department of Urology, Charité – Universitaetsmedizin Berlin, Berlin, Germany; 13Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain; 14Department of Urology, Clinique Pasteur, Toulouse, France
Introduction: GreenLight photoselective vaporization of the prostate (PVP) is a surgical treatment for benign prostatic hyperplasia (BPH) that yields comparable results to transurethral resection of the prostate while optimizing safety outcomes; yet, granular data is lacking for patients over the age of 80. The present study analyzed the largest international GreenLight database, the Global GreenLight Group, to evaluate the functional and safety profile of GreenLight PVP in octogenarians.
Methods: The Global GreenLight Group is a database comprised of patients that underwent GreenLight PVP from 2011–2019 performed by eight experienced urologists at seven different international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians, and were compared to all other PVP patients, labelled as the control group.
Results: Among 3648 patients, 586 men were above the age of 80. Compared to the control, octogenarians had larger prostates (76.0 vs. 71.9 ml, p=0.02) and a lower body mass index (25.6 vs. 26.7, p=0.045). They also had higher American Society of Anesthesiologists scores: 61.0% were considered high-medical-risk, i.e., had an ASA of 3 or greater, compared to 22.7% in the control group. Operative time was not significantly longer. The change in outcomes between 80-year-old patients and control patients was not significantly different one-year postoperative, with the exception of maximum urinary flow that favored younger patients (Table 1). The odds of transfusion were greater for older patients (odds ratio 8.2, 95% confidence interval 3.6–18.9, p<0.01) but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0% vs. 11.9%, p<0.01).
Conclusions: GreenLight PVP is an effective surgical option for treating symptomatic BPH in octogenarians and achieves similar functional outcomes compared to younger patients. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was also higher in octogenarians.
