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Minerva Urologica e Nefrologica 2020 Apr 10

DOI: 10.23736/S0393-2249.20.03597-3


lingua: Inglese

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 12, Giampaolo DELICATO 13, Antonino LAGANÁ 13, Claudio DADONE 14, Gaetano DE RIENZO 15, Andrea DITONNO 15, Antonio FRATTINI 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 of Chieti, Chieti, Italy; 3 Department of Urology, Humanitas Gavazzeni, Bergamo, Italy; 4 Department of Urology, "Sant'Andrea" Hospital, Sapienza University, Rome, Italy; 5 Department of Urology, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Sede Molinette, 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, “Rovereto Hospital”, Rovereto, Trento, Italy; 9 Department of Urology, “Ulivella e Glicini Clinic”, Florence, Italy; 10 Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; 11 Department of Urology, Clinica Urologica Azienda Ospedaliera, University of Padua, Padua, Italy; 12 Department of Urology, "Sant'Andrea" Hospital, Sapienza University, Rome, Italy; 13 Department of Urology, “S.Giovanni Evangelista” Hospital, Tivoli, Rome, Italy; 14 Department of Urology, “Santa Croce e Carle” Hospital, Cuneo, Italy; 15 Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; 16 Department of Urology, Ospedale Civile di Guastalla ed Ospedale Ercole Franchini di Montecchio Emilia, 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 UOSD Urologia, Dipartimento di Scienze Chirurgiche, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, 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 particular regard to the surgical techniques performed and the surgical and functional outcomes at mid term follow-up.
MATERIALS AND 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 anticoagulant/anti-aggregant. We recorded also the kind of anesthesia, mean laser time (min), mean irradiation time (min) , TURP conversion/completion rate, post-operative day of catheter removal, postoperative acute urinary retention (AUR), hospital stay, variation of haematocrit (Ht) and haemoglobin 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.The 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 CI 95% p = 0.3) and pre- intervention and post-intervention Hb levels (14.28 ± 1.46 vs 13.72 p = 0.35). Compared with the pre-operative 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). 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 Green Light 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: Greenlight laser; BPH; LUTS; Prostate; Multicentric

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