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Latest green-light laser effective for reducing large prostate volumes

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Treatment of benign prostatic hyperplasia with the latest version of the GreenLight photoselective vaporizing laser is effective in reducing lower urinary tract symptoms, “even in patients with larger prostates,” according to a report in European Urology online December 1.

“The key feature of the new 180-W XPS laser is faster speed of lasing and higher energy application,” the authors explain. The previous 80-W and 120-W versions of the GreenLight laser system (American Medical Systems) were considered too slow by some operators for reducing large prostate volumes (>80 mL). The new GreenLight 180-W XPS laser involving a new MoXy fiber delivers 50% more energy with a larger laser beam area.

Dr. Alexander Bachmann, at University Hospital Basel, Switzerland, and a multicenter team prospectively evaluated the performance of the XPS laser in 201 men with BPH. Prostate volume was greater than 80mL in 25.8% of the patients, between 40 and 80 mL in 47.9%, and less than 40 mL in 26.3%.

Average lasing time increased almost linearly from 13.4 minutes for prostate volumes less than 20 mL up to 61.8 minutes for volumes greater than 120 mL, the data indicate.

Intraoperative complications included impaired visibility due to bleeding in 10% and capsule perforation in 3.5%, the team found.

Mean follow-up was 5.8 months, during which time all functional outcomes except residual volume improved significantly, according to the report. Specifically, the International Prostate Symptom Score improved from 19.6 at baseline to 9.6 at 6 months, maximum flow rate increased from 8.4 to 21.0 mL/sec, and PSA dropped from 5.5 to 2.0 ng/mL.

During 1-3 months postop, mild dysuria occurred in 10.6% of patients and urinary tract infections were document in 2.8%, but no de novo erectile dysfunction was reported by any patient, Dr. Bachmann and colleagues report.

“Due to the 180-W higher power and the increased fibre durability, handling of the XPS procedure is easier and appears more efficient in terms of tissue removal,” they conclude.

However, they add, “Functional follow-up of a significantly larger number of patients with longer follow-up is needed to draw a final conclusion.”

Reference:

180-W XPS GreenLight Laser Therapy for Benign Prostate Hyperplasia: Early Safety, Efficacy, and Perioperative Outcome After 201 Procedures

Eur Urol 2011.