Safety profile of GreenLight XPS laser photoselective vaporisation of the prostate in patients at high risk of bleeding

Abstract

Objective:

This study aimed to assess the utility and safety profile of the GreenLight Xcelerated Performance System (XPS) photoselective vaporisation of the prostate (PVP) to treat benign prostatic hyperplasia (BPH) in high-risk patients.

Patients and methods:

A retrospective study of a prospectively managed database was carried out. The study reviewed a single surgeon’s experience of treating high-risk patients with GreenLight XPS PVP between two sites over a four-year period. Patients considered to be high risk were those who were at an increased risk of bleeding, those who had a prostate size >80 mL, those with preoperative urinary retention and/or those aged >80 years.

Results:

In total, 374 patients were identified as being high risk for GreenLight PVP. Patient age ranged from 44 to 96 years (M_age=71 years). Of the 374 patients, 103 were aged >80 years. All 374 patients were considered to be at an increased risk of bleeding, as they underwent GreenLight PVP while taking antiplatelet agents (not including aspirin), anticoagulant agents or both. Ninety-one patients had preoperative urinary retention and indwelling urinary catheter. Fifty-four patients had a prostate size >80 mL. Length of stay varied from 1 to 14 days. Most patients (n=270) were discharged on postoperative day 1. There were no perioperative blood transfusions. One patient developed acute coronary syndrome on postoperative day 4, requiring percutaneous coronary intervention. Twenty-two patients required readmission: 12 due to urinary retention with or without haematuria, and 10 due to haematuria without associated acute retention. Two patients required cystoscopy and bladder washout. There were two blood transfusions in the ‘readmission due to haematuria’ group. Outcomes for patients aged >80 years were favourable. The average length of stay was 2.7 days (range 1–14 days). This group was responsible for 12 of the 22 readmissions. There were no perioperative cardiovascular events.

Conclusion:

We conclude that GreenLight XPS PVP is a safe procedure in patients with one or more high-risk factors. The ability to proceed without the need to stop antiplatelets or anticoagulant agents also allows for high-risk medical patients to be treated without the additional risks of cardiovascular events.

Level of evidence:

Not applicable for this multicentre audit.

Keywords

Benign prostate disorders endourology core urology education training

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References

Wei

Calhoun

Jacobsen

Urologic Diseases in America project: benign prostatic hyperplasia. J Urol 2005; 173: 1256–1261.

Berry

Coffey

Walsh

, et al. The development of human benign prostatic hyperplasia with age. J Urol 1984; 132: 474–479.

Gratzke

Bachmann

Descazeaud

, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2015; 67: 1099–1109.

Whelan

Bowen

Burke

, et al. A prospective trial of GreenLight PVP (HPS120) versus transurethral resection of the prostate in the treatment of lower urinary tract symptoms in Ontario, Canada. Can Urol Assoc J 2013; 7: 335.

GreenLight XPS for treating benign prostatic hyperplasia, https://www.nice.org.uk/guidance/mtg29 (2016, accessed 13 January 2019).

The Department of Economic and Social Affairs of the United Nations. World Population Ageing https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf (2017, accessed 27 August 2019).

Raj

McDonald

Brooks

, et al. Stopping anticoagulation before TURP does not appear to increase perioperative cardiovascular complications. Urology 2011; 78: 1380–1384.

Descazeaud

Robert

Lebdai

, et al. Impact of oral anticoagulation on morbidity of transurethral resection of the prostate. World J Urol 2010; 29: 211–216.

Enver

Hoh

Chinegwundoh

The management of aspirin in transurethral prostatectomy: current practice in the UK. Ann R Coll Surg Engl 2006; 88: 280–283.

10.

Hahn

Farahmand

Hallin

, et al. Incidence of acute myocardial infarction and cause-specific mortality after transurethral treatments of prostatic hypertrophy. Urology 2000; 55: 236–240.

11.

Levine

Bates

Bittl

, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation 2016; 134.

12.

Schulz

Schuster

Mehilli

, et al. Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period. Eur Heart J 2009; 30: 2714–2721.

13.

Woo

Reich

Bachmann

, et al. Outcome of GreenLight HPS 120-W laser therapy in specific patient populations: those in retention, on anticoagulants, and with large prostates (⩾80 mL). Eur Urol Suppl 2008; 7: 378–383.

14.

Chen

Lin

Chiang

Outcome of GreenLight HPS laser therapy in surgically high-risk patients. Lasers Med Sci 2012; 28: 1297–1303.

15.

Hueber

Bienz

Valdivieso

, et al. Photoselective vaporization of the prostate for benign prostatic hyperplasia using the 180 Watt system: multicenter study of the impact of prostate size on safety and outcomes. J Urol 2015; 194: 462–469.

16.

Woo

West

Does prostate size impact upon perioperative outcomes associated with photoselective vaporization of the prostate using the 180W lithium triborate laser?

Urol Ann 2015; 7: 17.

17.

Knapp

Chalasani

Woo

Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180-W Greenlight lithium triborate laser. BJU Int 2017; 119: 33–38.

18.

Reich

Gratzke

Bachmann

, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 2008; 180: 246–249.

19.

Bachmann

Tubaro

Barber

, et al. 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European multicentre randomised trial – the GOLIATH Study. Eur Urol 2014; 65: 931–942.

20.

Bachmann

Tubaro

Barber

, et al. A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH Study. J Urol 2015; 193: 570–578.

21.

Thomas

Tubaro

Barber

, et al. A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH Study. Eur Urol 2016; 69: 94–102.

22.

Woo

Hossack

Photoselective vaporization of the prostate with the 120-W lithium triborate laser in men taking coumadin. Urology 2011; 78: 142–145.

23.

Sohn

Choi

Kim

, et al. Effectiveness and safety of photoselective vaporization of the prostate with the 120 W HPS GreenLight laser in benign prostatic hyperplasia patients taking oral anticoagulants. Korean J Urol 2011; 52: 178.

24.

Tao

Xue

Zang

, et al. The application of 120-W high-performance system GreenLight laser vaporization of the prostate in high-risk patients. Lasers Med Sci 2012; 28: 1151–1157.

25.

Elshal

Elkoushy

El-Nahas

, et al. GreenLight™ laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 2015; 193: 927–934.

26.

Charbonneau

Pasquié

Peyronnet

, et al. Stopping or maintaining Oral Anticoagulation in patients undergoing Photoselective vaporization of the prostate (SOAP) surgery for benign prostate obstruction: study protocol for a multicentre randomized controlled trial. Trials 2018; 19.