Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with extremely large prostates (prostate volume > 200 cc).

ObjectivesMethodsTo describe peri-operative results, functional outcomes and complications of laser photoselective vaporization, using the GreenLight system, of prostate glands 200mL in volume. Retrospective analysis of a prospectively maintained multicentre database was performed to select a subgroup of patients with very large prostates (volume 200mL) treated with the GreenLight XPS laser. A subgroup of patients with prostate volumes 100-200mL was used for comparison. International Prostate Symptom Score, maximum urinary flow rate, postvoid residual urine volume and prostate-specific antigen levels were measured at 6, 12, 24, 36 and 48months. Durability was evaluated using benign prostatic hyperplasia re-treatment rate at 12, 24 and 36months. Additionally, complications were recorded using Clavien-Dindo classification. ResultsConclusionsA total of 33 patients (38%) had prostates 200mL. Baseline characteristics were similar between patients with prostates 200mL and those with prostates 100-200mL. Patients with very large prostates (200mL) had longer operating times (129 vs 93min), less energy delivered, a greater number of fibres used (3 vs 2) and a higher conversion rate to transurethral resection of the prostate (16% vs 4%). In terms of complications and functional outcomes, we did not find any differences between the groups. Retreatment rate was also comparable. Our results show that PVP GreenLight XPS-180W is an acceptable technique for very large prostates (200mL); however, operating times, energy delivery, fibres used and conversion to TURP are a concern in this particular subgroup. This should be used for patient counselling and surgery planning.