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

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.