ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2022 August;74(4):467-74

DOI: 10.23736/S2724-6051.21.04145-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Green light laser enucleation of the prostate with early apical release is safe and effective: single center experience and revision of the literature

Giovanni FERRARI ¹, Salvatore RABITO ^{1, 2} ✉, Lorenzo GATTI ¹, Nicolas N. NTEP ¹, Ferdinando D. VITELLI ¹, Michele MARCHIONI ³, Bernardo M. ROCCO ², Salvatore MICALI ², Riccardo FERRARI ², Luca CINDOLO ^{1, 4}

¹ Department of Urology, Hesperia Hospital, CURE Group, Modena, Italy; ² Department of Urology, Sant’Agostino Estense Hospital, Modena, Italy; ³ Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio University, Chieti, Chieti-Pescara, Italy; ⁴ Department of Urology, Villa Stuart Private Hospital, Rome, Italy

BACKGROUND: Green Light laser enucleation of the prostate (GreenLEP) is an endoscopic treatment to treat bladder outlet obstruction in men with large prostate (>100 cc). Herein, we describe our GreenLEP series and describe its safety and efficacy.
METHODS: Between February 2014 and April 2019, 120 patients from a single center underwent en-bloc GreenLEP with early apical release. All procedures were performed with the AMS XPS laser generator (set: 120 W for vaporization and 20 W for coagulation). Morcellation was carried out with the Wolf Piranha morcellator. Data concerning the pre-, intra- and postoperative outcomes were prospectively collected. The follow-up data at 6, 12 months and at the last control were collected.
RESULTS: The median age was 66.0 (IQR: 61.0-71.0) years; 37.5% of the patients were under antiplatelet/anticoagulant therapy, 15.0% had indwelling catheter history. The median prostate volume and the baseline PSA value were 98.5 mL (IQR 83.0-130.0) and 4.2 ng/mL (IQR: 3.2-6.8), respectively. The median operative and lasing time were 65.0 (IQR: 51.0-83.5) and 6.0 (IQR: 6.0-10.0) minutes, respectively. In the postoperative period 1 patient was transfused. The median follow-up was 18.0 (IQR: 12.0-39.5) months. All patients had significant improvement in terms of improvement of uroflowmetry (median from 9 mL/sec [IQR 7.8, 11.0] to 20.0 [IQR 18.0, 22.0], P<0.001) and symptoms control (IPSS median score from 26.0 mL/sec [IQR 22.0, 28.0] to 7.0 [IQR 6.0, 8.0], P<0.001]) over time. After 12 months 1 patient complained of stress incontinence (1 pad/day) and 1 of “de novo” wet urgency.
CONCLUSIONS: En-bloc GreenLEP with early apical release is a safe and effective procedure even for large volume prostates. It allows us to limit the use of laser energy and shorten the operating times with stable and satisfactory long-term outcomes.

KEY WORDS: Lasers; Prostate; Endoscopy