Global trend of the peri- and post-operative outcomes in the application of photoselective vaporization of the prostate with the GreenLight - XPS 180Watt

Background: Benign Prostatic Hyperplasia (BPH) is one of the most common urological conditions in elderly men worldwide and is associated with a significant impairment in quality of life. Greenlight laser vaporization of the prostate (PVP) has emerged as a promising minimally invasive treatment option for BPH in recent years. The goal of the Global Greenlight Group was to investigate the effectiveness and safety of PVP in a large patient cohort with varying prostate volumes over the period from 2011 to 2019. Patients and methods: A total of 3441 men who underwent treatment for BPH between 2011 and 2019 at seven international centers with extensive surgical experience using the GreenLight-XPS 180-Watt system (GL-XPS) were included in the study. The primary parameters assessed were operative time (OT), effective laser time (LT), as well as intraoperative and postoperative complications. These were analyzed based on the year of surgery (2011 to 2019) and prostate volume (PV) groups (PV1 150 ml). Results: The median age was 70 years (IQR 64 - 77), and the median prostate volume was 64 ml (IQR 47 - 90). Approximately 35% of patients were taking oral anticoagulants. Operative time (OT) and laser time (LT) increased significantly between 2011 and 2019 but remained efficient with median values of 60 minutes (OT, IQR 45 - 83) and 33 minutes (LT, IQR 23 - 46). Energy consumption was 253 kJ (IQR 170 - 375) with an energy density of 3.94 kJ/ml (IQR 2.94 - 5.02). The likelihood of perioperative complications decreased by 17% over time. Perioperative transfusions significantly decreased from 2% (2011) to 0% (2019). Length of hospital stay and indwelling catheter duration remained unchanged. Early postoperative complications (<30 days postoperatively) decreased significantly from 48.8% (2011) to 24.7% (2019). Postoperative results showed a short hospital stay, significant symptom reduction over time, and decreasing complication rates. Reduction in LUTS (Lower Urinary Tract Symptoms) and urinary retention were particularly significant. Conclusion: This study highlights that PVP can be safely and effectively used, even for patients with a prostate volume exceeding 80 ml. This underscores the importance of this procedure in BPH treatment, especially in an aging and multimorbid patient population. This work contributes to a deeper understanding of the application of the Greenlight-XPS-180-Watt system for prostate hyperplasia treatment and confirms its efficacy and safety, even for large prostate volumes. These results are of clinical significance due to the large patient cohort and international applicability, and they can support decision-making in the treatment of patients with prostate hyperplasia.Hintergrund: Das Benigne Prostatasyndrom (BPS) stellt weltweit eine der häufigsten urologischen Erkrankungen bei älteren Männern dar und geht mit einer erheblichen Beeinträchtigung der Lebensqualität einher. Die Greenlight-Laservaporisation der Prostata (PVP) hat sich in den letzten Jahren als eine vielversprechende minimal-invasive Therapieoption für das BPS etabliert. Ziel der Global Greenlight Group war es, die Effektivität und Sicherheit der PVP an einer großen Patienten - Kohorte mit unterschiedlichen Prostatavolumina über einen Zeitraum von 2011 bis 2019 hinweg zu untersuchen. Patienten und Methoden: Es wurden 3441 Männer eingeschlossen, die zwischen 2011 und 2019 aufgrund eines BPS an sieben internationalen Zentren mit hoher operativer Erfahrung mittels GreenLight-XPS 180-Watt-System (GL – XPS) behandelt wurden. Die primären Parameter waren die Operationszeit (OZ), die effektive Laserzeit (LZ) sowie intra- und postoperative Komplikationen. Diese wurden nach Operationsjahren (2011 bis 2019) und Prostatavolumen (PV) - Gruppen (PV1 150 ml) analysiert. Ergebnisse: Das mediane Alter betrug 70 Jahre (IQA 64 - 77) und das mediane Prostatavolumen 64 ml (IQA 47 – 90). Etwa 35 % der Patienten nahmen orale Antikoagulanzien ein. Die Operations- (OZ) und Laserzeit (LZ) stiegen zwischen 2011 und 2019 signifikant an, blieben aber mit medianen Werten von 60 min (OZ, IQA 45 – 83) bzw. 33 min (LZ, IQA 23 - 46) effizient. Der Energieverbrauch lag bei 253 kJ (IQA 170 – 375) mit einer Energiedichte von 3,94 kJ/ml (IQA 2,94 – 5,02). Die Wahrscheinlichkeit perioperativer Komplikationen nahm im zeitlichen Verlauf um insgesamt 17 % ab. Perioperative Transfusionen reduzierten sich signifikant von 2 % (2011) auf 0 % (2019). Die stationäre Verweildauer und Dauerkatheter-Verweildauer blieben unverändert. Frühe postoperative Komplikationen (< 30 Tage postoperativ) sanken signifikant von 48,8 % (2011) auf 24,7 % (2019). Die postoperativen Ergebnisse zeigen eine kurze Krankenhausverweildauer, eine im Verlauf signifikante Symptomreduktion, sowie sinkende Komplikationsraten. Besonders die Reduktion von LUTS und Harnverhalten waren signifikant. Schlussfolgerungen: Diese Studie hebt hervor, dass die PVP sicher und effektiv auch für Patienten mit einem Prostatavolumen von über 80 ml angewendet werden kann. Dies unterstreicht die Bedeutung dieses Verfahrens in der Behandlung des BPS, insbesondere in einer alternden und multimorbiden Patientenpopulation. Die vorliegende Arbeit trägt dazu bei, das Verständnis für die Anwendung des Greenlight-XPS-180-Watt-Systems zur Behandlung der Prostatahyperplasie zu vertiefen und bestätigt seine Wirksamkeit und Sicherheit, auch bei großen Prostatavolumina. Diese Ergebnisse sind aufgrund der großen Patientenkohorte und ihrer internationalen Anwendbarkeit von klinischer Bedeutung und können die Entscheidungsfindung bei der Behandlung von Patienten mit Prostatahyperplasie unterstützen

Global experience and progress in GreenLight-XPS 180-Watt photoselective vaporization of the prostate

Purpose: To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. Methods: 3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011–2019) and prostate volume (PV) group ( 150 ml). Results: The median age was 70 years (interquartile range 64–77), the median PV was 64 ml (IQR 47–90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45–83) and LT was 33 min (IQR 23–46). Median energy use was 253 kJ (IQR 170–375) with an energy density of 3.94 kJ/ml (IQR 2.94–5.02). The relative probability of perioperative AEs decreased by 17% each year (p  0.001). Conclusion: These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience

Renal Allograft Compartment Syndrome: A Case Report and Review of the Literature

Kidney transplantation is the treatment of choice for patients with ESRD. One rare complication after transplantation is the development of renal allograft compartment syndrome (RACS). We present a case of 1 patient who developed RACS due to compression of the transplant vein, which was then treated by salvaging the kidney transplant using urgent decompression surgery with mesh fascial closure. We postulate that this technique is safe and should be the treatment of choice for patients with RACS

Genetic Risk Score for Intracranial Aneurysms: Prediction of Subarachnoid Hemorrhage and Role in Clinical Heterogeneity

Background: Recently, common genetic risk factors for intracranial aneurysm (IA) and aneurysmal subarachnoid hemorrhage (ASAH) were found to explain a large amount of disease heritability and therefore have potential to be used for genetic risk prediction. We constructed a genetic risk score to (1) predict ASAH incidence and IA presence (combined set of unruptured IA and ASAH) and (2) assess its association with patient characteristics. Methods: A genetic risk score incorporating genetic association data for IA and 17 traits related to IA (so-called metaGRS) was created using 1161 IA cases and 407 392 controls from the UK Biobank population study. The metaGRS was validated in combination with risk factors blood pressure, sex, and smoking in 828 IA cases and 68 568 controls from the Nordic HUNT population study. Furthermore, we assessed association between the metaGRS and patient characteristics in a cohort of 5560 IA patients. Results: Per SD increase of metaGRS, the hazard ratio for ASAH incidence was 1.34 (95% CI, 1.20-1.51) and the odds ratio for IA presence 1.09 (95% CI, 1.01-1.18). Upon including the metaGRS on top of clinical risk factors, the concordance index to predict ASAH hazard increased from 0.63 (95% CI, 0.59-0.67) to 0.65 (95% CI, 0.62-0.69), while prediction of IA presence did not improve. The metaGRS was statistically significantly associated with age at ASAH (β=-4.82×10-3per year [95% CI, -6.49×10-3to -3.14×10-3]; P=1.82×10-8), and location of IA at the internal carotid artery (odds ratio=0.92 [95% CI, 0.86-0.98]; P=0.0041). Conclusions: The metaGRS was predictive of ASAH incidence, although with limited added value over clinical risk factors. The metaGRS was not predictive of IA presence. Therefore, we do not recommend using this metaGRS in daily clinical care. Genetic risk does partly explain the clinical heterogeneity of IA warranting prioritization of clinical heterogeneity in future genetic prediction studies of IA and ASAH