Ghahhari Jamil, D'Orta Carlo, Rizzoli Ambra, Marchioni Michele, Primicer Giulia I, De Francesco Piergustavo, Civitella Angelo, Di Lecce Mario, Castellan Pietro, Castellucci Roberto, Neri Fabio, Tamburro Fabiola Raffaella, Cindolo Luca, Schips Luigi
Department of Urology, SS. Annunziata Hospital , "G.D'Annunzio" University of Chieti, Chieti, Italy.
Department of Urology, "S. Pio da Pietrelcina" Hospital, Vasto, Italy.
Surg Technol Int. 2018 Jun 1;32:164-172.
In our study, we reported on our monocenter experience with GreenLight (GL) Xcelerated Performance System (XPS) /MoXy laser fiber (American Medical Systems Inc., Minnetonka, Minnesota), examining its efficacy, safety, and its ability to effectively treat lower urinary tract symptoms (LUTS) in benign prostate obstruction (BPO). We also explored and compared the three different endoscopic approaches used for GL treatment of benign prostatic hyperplasia (BPH), standard photovaporization (PVP), anatomical PVP, and GreenLight XPS enucleation of the prostate.
Between February 2013 and April 2017, 140 patients, with an average age of 67.7 years (range 47-85), were treated using the XPS/MoXy system in a single-operative urologic center. The data were retrospectively analyzed with an assessment of the main intra- and postoperative outcomes at three, six, 12, and 18 months comparing both subjective (international prostate symptom score [IPSS]) and objective (uroflow [Qmax] parameters and prostate volume) parameters to the preoperative data. Patients underwent standard PVP, anatomical PVP, or prostate photo-selective en-bloc enucleation (PEBE) according to surgeon preferences.
Median prostate volume (MPV) and prostate-specific antigen (PSA) were 69cc and 3.24 ng/dl, respectively. An indwelling catheter, at the time of surgery, was observed in 15% of men. Median operative-laser time and energy applied were 56.4 minutes, 26.5 minutes, and 245813 kJ. Outpatient surgery was feasible with median length of stay at 48 hours. Significant improvement in IPSS and Qmax are observed at all endpoints. No significant intraoperative complications were reported. When stratifying postoperative complications according to the Cavien-Dindo classification, only two cases of high-degree emerged (grades III-IV).
Our data confirm that in treating men with symptomatic benign prostate disease, the GreenLight XPS/MoXy laser fiber is safe and able to achieve challenging results in terms of clinical outcomes and prostate volume reduction. Balance between functional outcomes and complications was great without statistically significant differences, in terms of outcomes, between the different surgical techniques.
在我们的研究中，我们报告了我们在单中心使用GreenLight（GL）Xcelerated Performance System（XPS）™/MoXy™激光光纤（美国美敦力公司，明尼苏达州明尼通卡）的经验，研究其在良性前列腺梗阻（BPO）中治疗下尿路症状（LUTS）的疗效、安全性及有效性。我们还探讨并比较了用于GL治疗良性前列腺增生（BPH）的三种不同内镜方法，即标准光汽化术（PVP）、解剖性PVP和GreenLight XPS™前列腺剜除术。
2013年2月至2017年4月期间，在一家泌尿外科单中心，使用XPS™/MoXy™系统对140例平均年龄67.7岁（范围47 - 85岁）的患者进行了治疗。对数据进行回顾性分析，评估术后3个月、6个月、12个月和18个月的主要术中及术后结果，将主观（国际前列腺症状评分[IPSS]）和客观（尿流率[Qmax]参数及前列腺体积）参数与术前数据进行比较。根据外科医生的偏好，患者接受标准PVP、解剖性PVP或前列腺光选择性整块剜除术（PEBE）。
前列腺体积中位数（MPV）和前列腺特异性抗原（PSA）分别为69立方厘米和3.24纳克/分升。手术时15%的男性留置了导尿管。手术激光时间中位数和能量分别为56.4分钟、26.5分钟和245813千焦。门诊手术可行，住院时间中位数为48小时。在所有观察终点，IPSS和Qmax均有显著改善。未报告重大术中并发症。根据Cavien-Dindo分类对术后并发症进行分层时，仅出现两例严重并发症（III - IV级）。
我们的数据证实，在治疗有症状的良性前列腺疾病患者时，GreenLight XPS™/MoXy™激光光纤是安全的，并且在临床结果和前列腺体积缩小方面能够取得具有挑战性的成果。不同手术技术在功能结果和并发症之间取得了良好平衡，在结果方面无统计学显著差异。
