The impact of 5-ARI on perioperative and functional outcomes of GreenLight PVP: an analysis of the Global GreenLight Group database.

INTRODUCTION: In this study, we sought to investigate the impact of 5-alpha reductase inhibitors (5-ARI) on the perioperative and functional outcomes of 180-Watt XPS GreenLight photovaporization of the prostate (PVP) using a large international database. MATERIALS AND METHODS: Data were obtained from the Global GreenLight Group (GGG) database, which includes eight high-volume, experienced surgeons from seven international centers.  All men with established benign prostatic hyperplasia (BPH) with known 5-ARI status who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible for the study.  Patients were assigned to two groups based on the preoperative use of 5-ARI.  Analyses were adjusted for patient age, prostate volume, and American Society of Anesthesia (ASA) score. RESULTS: We included 3,500 men, of which 1,246 (36%) had preoperative 5-ARI use.  Patients in both groups were similar with regards to age and prostate size.  On multivariable analysis, total operative time was slightly shorter (-3.26 min 95% CI: 1.20 - 5.32, p < 0.01) and required 35.6kJ less laser energy (95% CI: -48.0kJ - -23.3kJ, p < 0.01) for patients on 5ARI compared to those without 5-ARI.  However, no clinically significant difference was appreciated regarding postoperative transfusion rates [OR 0.048 (95% CI -0.82-0.91; p = 0.91)], hematuria rates [OR 0.96 (95% CI 0.72-1.3; p = 0.81)], 30-day readmission rates [OR 0.98 (95% CI 0.71-1.4; p = 0.90)], or overall functional outcomes. CONCLUSION: Our findings suggest that preoperative 5-ARI is not associated with any clinically significant different perioperative or functional outcomes for GreenLight PVP using the XPS-180W system.  There is no role for the initiation or discontinuation of 5-ARI prior to GreenLight PVP.

Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database.

INTRODUCTION: The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians. METHODS: The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80. RESULTS: Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9 ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Qmax) that favoured younger patients (10.3 vs 12.6 ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6-18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01). CONCLUSIONS: GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.

Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database.

INTRODUCTION: GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80 cc) vs. small prostates (< 80 cc). METHODS: Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe. RESULTS: 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12 months (p = 0.005). There were no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). CONCLUSIONS: Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80 cc, with durable outcomes relatively independent from prostate size.

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 (< 80 ml vs. 80-150 ml vs. > 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). The relative probability of perioperative transfusion dropped significantly from 2% in 2011 to 0% in 2019 (p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (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.

GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database.

PURPOSE: We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database. METHODS: Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume. RESULTS: In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6-152.6, p < 0.01). CONCLUSION: We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.

Robotic surgery at ABC Medical Center: first 500 procedures experience.

BACKGROUND: Robotic surgery is a technological advance that is used in multiple surgical specialties in the world. Its acceptance in various areas has been supported by comparative studies with laparoscopic surgery and open surgery. OBJECTIVE: To document the robotic surgery program initial experience in a private hospital of Mexico City by analyzing its results and complications. MATERIAL AND METHOD: The first 500 robotic surgeries practiced at ABC Medical Center were included, covering a three-year period (January 2017 to December 2019). The following was documented: specialties involved, surgeries broken down by specialty and type of surgery, surgical times, complications and number of doctors involved in the initial experience. RESULTS: Out of 500 patients, 367 (73.4 %) were males and 133 (26.4 %) were females. The three most common surgeries were radical prostatectomy (269), hysterectomy (64) and inguinal repair (33). Average age was 58 years (range: 18 to 90 years). A total of 40 certified surgeons from five specialties performed all the procedures. CONCLUSIONS: Starting a program in a private medical center has several implications. The creation of a robotic surgery committee made up of certified robotic surgery specialists from each specialty and hospital authorities for the accreditation of guidelines for both certification and recertification of their doctors can benefit programs like ours by creating a center of excellence in robotic surgery and thus reduce complications and improve results.

ANTECEDENTES: La cirugía robótica se utiliza en múltiples especialidades quirúrgicas a nivel mundial. OBJETIVO: Documentar la experiencia inicial del programa de cirugía robótica en un hospital de práctica privada. MATERIAL Y MÉTODO: Se incluyen las primeras 500 cirugías robóticas realizadas en el Centro Médico ABC, abarcando un periodo de tres años. Se documentan especialidades involucradas así como datos transoperatorios principales. RESULTADOS: De 500 pacientes, 367 (73.4%) fueron de sexo masculino y 133 (26.4%) de sexo femenino. Las tres cirugías más realizada fueron prostatectomía radical (269), seguido de histerectomía (64) y plastia inguinal (33). Un total de 40 médicos certificados de cinco especialidades realizaron la totalidad de los procedimientos. CONCLUSIONES: El iniciar un programa en un centro médico privado tiene diversas implicaciones. La creación de un comité de cirugía robótica integrado por médicos especialistas certificados en cirugía robótica de cada especialidad y autoridades del hospital para la acreditación de lineamientos tanto para la certificación como la recertificación de sus médicos puede beneficiar a programas como el nuestro por crear un centro de excelencia de cirugía robótica, disminuyendo complicaciones y mejorando resultados.

Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety.

INTRODUCTION: Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. METHODS: Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. RESULTS: At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64-77), 64 (47-90), 3.1 ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62 min (46-85), respectively. Median energy use was 250.0 kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.

Cirugía robótica en el Centro Médico ABC: experiencia en los primeros 500 procedimientos realizados / Robotic surgery at ABC Medical Center: first 500 procedures experience

Resumen Antecedentes: La cirugía robótica se utiliza en múltiples especialidades quirúrgicas a nivel mundial. Objetivo: Documentar la experiencia inicial del programa de cirugía robótica en un hospital de práctica privada. Material y método: Se incluyen las primeras 500 cirugías robóticas realizadas en el Centro Médico ABC, abarcando un periodo de tres años. Se documentan especialidades involucradas así como datos transoperatorios principales. Resultados: De 500 pacientes, 367 (73.4%) fueron de sexo masculino y 133 (26.4%) de sexo femenino. Las tres cirugías más realizada fueron prostatectomía radical (269), seguido de histerectomía (64) y plastia inguinal (33). Un total de 40 médicos certificados de cinco especialidades realizaron la totalidad de los procedimientos. Conclusiones: El iniciar un programa en un centro médico privado tiene diversas implicaciones. La creación de un comité de cirugía robótica integrado por médicos especialistas certificados en cirugía robótica de cada especialidad y autoridades del hospital para la acreditación de lineamientos tanto para la certificación como la recertificación de sus médicos puede beneficiar a programas como el nuestro por crear un centro de excelencia de cirugía robótica, disminuyendo complicaciones y mejorando resultados.

Abstract Background: Robotic surgery is used in different surgical specialties worldwide. Objective: To documents the initial experience in a private hospital in the use robotic surgery in different surgical areas. Material and Methods: We included the first 500 robotic surgeries in our hospital in a 3 year period, documenting specialty and operative information. Results: Of the 500 patients, 367 (73.4%) were male and 133 (26.4%) female. The three most frequent surgeries performed were Radical Prostatectomy (269), Hysterectomy (64) an inguinal repair (33). A total of 40 certified surgeons ranging from 5 specialties performed the total number of surgeries. Conclusions: There are several implications in starting a robotic program in a private hospital setting. The creation of a robotic committee, formed by robotic certified physicians and hospital authorities, has helped in the certification process of its staff, lowering the complication rate and obtaining better surgical results.

Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database.

OBJECTIVES: Previous analyses of the impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180 W XPS GreenLight PVP using a large international database. METHODS: Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score. RESULTS: A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22-10.23; p < 0.01) minutes and 2.90 (95% CI 1.02-4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11-3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6 months which was 46.51 ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes. CONCLUSIONS: Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.

Utilización del cabestrillo pubovaginal en el tratamiento de la incontinencia urinaria de esfuerzo. Experiencia en el Servicio de Urología del Hospital / Sling suspension in urinary stress incontinence. Experience in the Hospital General de México. Department of urology

Objetivo: Demostrar la efectividad en el tratamiento de incontinencia urinaria de esfuerzo tipo 3 y recidivantes con la utilización del cabestrillo pubovaginal, así como la prevención de las complicaciones de ésta técnica. Material y métodos: Fueron analizadas en forma retrospectiva y prospectiva 13 pacientes en el Servicio de Urología del Hospital General de México, con diagnóstico de incontinencia urinaria de esfuerzo tipo 3, quienes fueron sometidos a un procedimiento de cabestrillo pubovaginal. Las 13 mujeres fueron evaluadas preoperatoriamente con historia clínica neurológica, exploración física, cuestionario de incontinencia, examen general de orina, urocultivo y exudado vaginal, así como mediante cistoscopia con prueba de Bonney-Marshall y estudio urodinámico en todos los casos. Resultados: Se llevaron a cabo 13 procedimientos de cabestrillo pubovaginal, en 12 por incontinencia urinaria tipo 3 (92 por ciento) y en la restante por incontinencia urinaria mixta (7.6 por ciento); la edad promedio fue de 46.8 años (rango de 31 a 72 años). El porcentaje de cura de incontinencia de esfuerzo fue del 92 por ciento (12 casos); la mujer restante presentó incontinencia de urgencia que fue manejada con medicamentos anticolinérgicos. Conclusiones: El cabestrillo pubovaginal es un tratamiento efectivo que es útil en los casos de incontinencia urinaria de esfuerzo por deficiencia intrínseca del esfínter (tipo 3), así como en aquellas pacientes con antecedentes de cirugías previas para incontinencia fallida con una tasa de éxito alcanzada del 92 por ciento. El principal problema relacionado al procedimiento fue la presencia de inestabilidad vesical, la cual es temporal hasta en un 46 por ciento, respondiendo satisfactoriamente al tratamiento médico; el segundo problema al que nos enfrentamos fue la obstrucción infravesical documentada por estudio urodinámico hasta en 38 por ciento, relacionándose clínicamente con los casos que presentaron retención urinaria y que no contaron con control cistoscópico durante el transoperatorio.