GreenLight XPS: our approach
The photoselective vaporization of the prostate with the surgical technology of straight beam lithium triborate laser (LBO) is considered one of the most promising alternatives for the treatment of benign prostatic hyperplasia (BPH). The aim of the present work is to share our initial experience of the 180-W straight beam LBO laser photoselective vaporesection of the prostate to evaluate the technical improvement. Our approach and technique for GreenLight XPS (180 W GreenLight Laser) drawing on personal experience with both anatomic and standard vaporization techniques were applied in 63 cases.
Materials and Methods
From April 2015 to December 2016 we performed 63 procedures. All patients were preoperatively assessed with the International Prostate Symptom Score (IPSS), post-avoid residual urine (PVR), prostate-specific-antigen level and prostate volume measurement. Perioperative parameters and complications were recorded.
Patients were assessed at 1 week and 1 month postoperatively. A transurethral cystoscopy was performed 3 months after the procedure
This technique resulted in a significant improvement of IPSS and PVR. Mean operative time was 50 minutes. The mean prostate volume was 60 ml. Applied energy of 250 KJ and a laser working time of 30 minutes were applied. The percentage of urinary retention after the Green light procedure was 20%. This percentage was reduced increasing catheter indwelling and hospital stay time to 48 hours instead 24 hours.
We recorded one case of fistole prostate with right adductor muscle, two case of persistent urinary incontinence (over 6 months) and one case of blood transfusion during the recovery. Finally, one case of capsule perforation was noticed
Currently TURP is still the gold standard in the surgical treatment of BPH. Our results demonstrate that the LBO laser photoselective vaporesection of the prostate has equally efficacy and greater safety compared with TURP especially for the elderly and high-risk patients with oral anticoagulation and bleeding tendency. By means of the GreenLight XP 180 watt laser anatomic photoselective vaporization of the prostate instead of standard vaporization, we observed an improvement of surgical outcomes and obstructive symptoms with smaller catheter indwelling time. The anatomic vaporization is a partial enucleation of prostatic adenoma from prostate capsule and tissue vaporization from capsule to lumen. Moreover, this technique decreased postoperative irritative symptoms
The XPS GreenLight Laser is a system that allows the urologist to perform an effective treatment option for BPH. The main positive features are the following: length of hospital stay and operative catheter time reduction, less surgical bleeding.
The XPS GreenLight Laser is a system that afford the urologist an effective treatment option for BPH however with shorter length of stay in hospital, less operative catheter time and surgical bleeding. The cost of one fiber is 1200 € that is more expansive that a TURP procedure but we have to consider that a patient can be dismissed 24 hours after the procedure without catheter. We have been able to treat larger gland (until 80 ml) with significantly quicker operative time without compromise surgical outcomes and significant complications. Moreover, the XPS GreenLight Laser can be a chance to patients which can’t be undergone traditional surgery
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