ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2020 October;72(5):622-8

DOI: 10.23736/S0393-2249.20.03597-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Operative profile, safety and functional outcomes after GreenLight laser prostate surgery: results from a 12 months follow-up multicenter Italian cohort analyses

Giulio REALE ¹ ✉, Michele MARCHIONI ², Vincenzo ALTIERI ³, Francesco GRECO ³, Cosimo DE NUNZIO ⁴, Paolo DESTEFANIS ⁵, Stefano RICCIARDULLI ⁶, Franco BERGAMASCHI ⁶, Giuseppe FASOLIS ⁷, Francesco VARVELLO ⁷, Salvatore VOCE ¹, Fabiano PALMIERI ¹, Claudio DIVAN ⁸, Gianni MALOSSINI ⁸, Rino ORITI ⁹, Agostino TUCCIO ¹⁰, Lorenzo RUGGERA ¹¹, Andrea TUBARO ⁴, Giampaolo DELICATO ¹², Antonino LAGANÀ ¹², Claudio DADONE ¹³, Gaetano DE RIENZO ¹⁴, Andrea DITONNO ¹⁴, Antonio FRATTINI ^{15, 16}, Luigi PUCCI ¹⁷, Maurizio CARRINO ¹⁷, Franco MONTEFIORE ¹⁸, Stefano GERMANI ¹⁹, Roberto MIANO ¹⁹, Luigi SCHIPS ², Salvatore RABITO ²⁰, Giovanni FERRARI ²⁰, Luca CINDOLO ²¹

¹ Department of Urology, S. Maria delle Croci Hospital, Azienda AUSL Romagna, Ravenna, Italy; ² Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio University, Chieti, Italy; ³ Department of Urology, Humanitas Gavazzeni, Bergamo, Italy; ⁴ Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy; ⁵ Departement of Urology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy; ⁶ Department of Urology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; ⁷ Department of Urology, S. Lazzaro Hospital, Alba, Cuneo, Italy; ⁸ Department of Urology, Hospital of Rovereto, Rovereto, Milan, Italy; ⁹ Department of Urology, Ulivella e Glicini Clinic, Florence, Italy; ¹⁰ Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; ¹¹ Department of Urology, Urologic Clinic, University of Padua, Padua, Italy; ¹² Department of Urology, S.Giovanni Evangelista Hospital, Tivoli, Rome, Italy; ¹³ Department of Urology, Santa Croce e Carle Hospital, Cuneo, Italy; ¹⁴ Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; ¹⁵ Department of Urology, Ospedale Civile di Guastalla, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; ¹⁶ Ercole Franchini di Montecchio Emilia Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; ¹⁷ Department of Urology, AORN Antonio Cardarelli, Naples, Italy; ¹⁸ Department of Urology, San Giacomo Hospital, Novi Ligure, Alessandria, Italy; ¹⁹ Unit of Urology, Department of Surgery, Tor Vergata Polyclinic Foundation, Tor Vergata University, Rome, Italy; ²⁰ Department of Urology, Hesperia Hospital, Modena, Italy; ²¹ Department of Urology, Villa Stuart Private Hospital, Rome, Italy

BACKGROUND: Over the two past decades, GreenLight laser therapy has been considered a valid alternative for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia/benign prostatic obstruction (BPH/BPO). However, the debate on the effectiveness of laser therapy compared to conventional techniques is still open. The aim of our study is to analyze and describe the use of GreenLight laser prostate surgery in Italy, with regard to the surgical techniques performed and the surgical and functional outcomes at mid-term follow-up.
METHODS: From March 2012 to July 2018, patients who underwent GreenLight laser prostate surgery for LUTS due to BPH/BPO from 19 Italian centers were included. The following parameters were evaluated in the population: age, prostate volume, prostate adenoma volume, PSA tot, Qmax at uroflowmetry (UFM), International Prostatic Symptoms Score (IPSS), previous therapy for LUTS, use of anticoagulants and antiplatelet drugs. We recorded also the kind of anesthesia, mean laser time (min), mean irradiation time (min), TURP conversion/completion rate, postoperative day of catheter removal, postoperative acute urinary retention (AUR), hospital stay, variation of hematocrit (Ht) and hemoglobin levels (Hb). Early complications were classified according to the Clavien-Dindo classification, the re-operation rate within 30 days and after 30 days, the late complications and the Patient Global Impression of Improvement were also collected. Changes over time in terms of blood loss and functional outcomes (IPSS and Qmax at the UFM at 6 and 12 months) were tested with Student’s test for paired samples. We assumed P≤0.05 as level of statistical significance.
RESULTS: Overall, 1077 were enrolled in the study, 554 (56.4%) were treated with standard vaporization and 523 (48.6%) with anatomical vaporization. Student’s t-test for paired samples showed no statistically significant differences in terms of reduction of Ht preoperative vs. Ht postoperative (42.80±3.91 vs. 39.93±5.35 95% CI P=0.3) and preintervention and postintervention Hb levels (14.28±1.46 vs. 13.72 P=0.35). Compared with the preoperative Qmax (8.60±2.64), the 6- and 12-month UFM showed a significant improvement [19.56±6.29, P<0.01 and 19.99±5.92 P<0.01]. In terms of IPSS variation, compared to the baseline level (22±5.51) the 6- and 12-month follow-up confirmed a significant reduction (8.01±4.41 P<0.01 and 5.81±4.12 P<0.01 respectively). Postoperative complications were CD0, CD1, CD2, CD3, CD4 in 33.0%,35.3%, 2.9%, 0.3%, and 0.6%.
CONCLUSIONS: To the best of our knowledge, this is one of the most numerous surgical series of GreenLight laser vaporization and with the longest follow-up. This technique should be considered as a safe and effective alternative in the treatment of secondary LUTS to BPH.

KEY WORDS: Lasers; Prostatic hyperplasia; Urinary tract infections