Objective: The objective was to assess and publish our first experiences with the GreenLight XPS™ 180-watt laser in men suffering from bladder outlet obstruction. Patients and Methods: From January 2013 to February 2014, the results of 142 patients were analyzed prospectively at a single center. Indications for disobstruction were in line with current EAU guidelines, but independent of the underlying causes of obstruction. Assessments were made of the prostate size, International Prostate Symptom Score (IPSS), postvoid residual (PVR) and maximum urinary flow (Qmax). Intraoperative data such as lasing time, surgery time, applied energy and blood transfusions were recorded. Reinterventions and complications were evaluated. Results: The average prostate volume was 29.6 ml (2-82). The average surgery time was 50 min (13-157). Qmax increased by an average of 20.2 ml/s (p < 0.05). On average, PVR was reduced by 162 ml (p < 0.05). Conclusion: The GreenLight XPS™ 180-watt laser is an effective treatment option for bladder outlet obstruction with a low perioperative complications rate, and it shows results comparable with transurethral resection of the prostate. Even multimorbid patients and patients with long-term catheter requirements may be treated due to its high safety profile and reliable results.

1.
Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N'Dow J, Nordling J, de la Rosette JJ; European Association of Urology: EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013;64:118-140.
2.
Willder JM, Walker VC, Halbert GL, Dick CP, Orange C, Qayyum T, Horgan PG, Underwood MA, Edwards J: Body mass index predicts failure of surgical management in benign prostatic hyperplasia. Urol Int 2013;90:150-155.
3.
Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG; Urology Section of the Bavarian Working Group for Quality Assurance: Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 2008;180:246-249.
4.
Netsch C, Tiburtius C, Bach T, Knipper S, Gross AJ: Association of prostate size and perioperative morbidity in thulium:YAG vapoenucleation of the prostate. Urol Int 2014;93:22-28.
5.
Malek RS, Barrett DM, Kuntzman RS: High-power potassium-titanyl-phosphate (KTP/532) laser vaporization prostatectomy: 24 h later. Urology 1998;51:254-256.
6.
Seifert HH, Hermanns T, Sulser T: GreenLight laser vaporisation of the prostate for treatment of benign prostatic hyperplasia. Development and significance (in German). Urologe A 2008;47:964-968.
7.
Hai MA, Malek RS: Photoselective vaporization of the prostate: initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia. J Endourol 2003;17:93-96.
8.
Sulser T, Reich O, Wyler S, Ruszat R, Casella R, Hofstetter A, Bachmann A: Photoselective KTP laser vaporization of the prostate: first experiences with 65 procedures. J Endourol 2004;18:976-981.
9.
Reich O, Bachmann A, Siebels M, Hofstetter A, Stief CG, Sulser T: High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients. J Urol 2005;173:158-160.
10.
Bachmann A, Schurch L, Ruszat R, Wyler SF, Seifert HH, Muller A, Lehmann K, Sulser T: Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): a prospective bi-centre study of perioperative morbidity and early functional outcome. Eur Urol 2005;48:965-971; discussion 972.
11.
Barber NJ, Zhu G, Donohue JF, Thompson PM, Walsh K, Muir GH: Use of expired breath ethanol measurements in evaluation of irrigant absorption during high-power potassium titanyl phosphate laser vaporization of prostate. Urology 2006;67:80-83.
12.
Te AE: The next generation in laser treatments and the role of the GreenLight high-performance system laser. Rev Urol 2006;8(suppl 3):S24-S30.
13.
Rieken M, Bonkat G, Müller G, Wyler S, Mundorff NE, Puschel H, Gasser T, Bachmann A: The effect of increased maximum power output on perioperative and early postoperative outcome in photoselective vaporization of the prostate. Lasers Surg Med 2013;45:28-33.
14.
Bachmann A, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyere F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitan C, Knispel H, Thomas JA: 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European multicentre randomised trial - the GOLIATH study. Eur Urol 2014;65:931-942.
15.
Gómez Sancha F, Bachmann A, Choi BB, Tabatabaei S, Muir GH: Photoselective vaporization of the prostate (GreenLight PV): lessons learnt after 3,500 procedures. Prostate Cancer Prostatic Dis 2007;10:316-322.
16.
Muir G, Gómez Sancha F, Bachmann A, Choi B, Collins E, et al: Techniques and training with GreenLight HPS 120-W laser therapy of the prostate: position paper. Eur Urol Suppl 2008;7:370-377.
17.
Zorn KC, Liberman D: Greenlight 180W XPS photovaporization of the prostate: how I do it. Can J Urol 2011;18:5918-5926.
18.
Broggi E, May A, Giretti G, Tabchouri N, Lorphelin H, Brichart N, Bruyere F: Long-term outcomes of 80-watt KTP and 120-watt HPS GreenLight photoselective vaporization of the prostate. Urol Int 2014;93:229-236.
19.
Ben-Zvi T, Hueber PA, Liberman D, Valdivieso R, Zorn KC: GreenLight XPS 180W versus HPS 120W laser therapy for benign prostate hyperplasia: a prospective comparative analysis after 200 cases in a single-center study. Urology 2013;81:853-858.
20.
Emara AM, Barber NJ: The continuous evolution of the GreenLight laser; the XPS generator and the MoXy laser fiber, expanding the indications for photoselective vaporization of the prostate. J Endourol 2014;28:73-78.
21.
Choi H, Kim JH, Shim JS, Park JY, Kang SH, Moon du G, Cheon J, Lee JG, Kim JJ, Bae JH: Prediction of persistent storage symptoms after transurethral resection of the prostate in patients with benign prostatic enlargement. Urol Int 2014;93:425-430.
22.
Park JH, Son H, Paick JS: Comparative analysis of the efficacy and safety of photoselective vaporization of the prostate for treatment of benign prostatic hyperplasia according to prostate size. Korean J Urol 2010;51:115-121.
23.
Bouchier-Hayes DM, Van Appledorn S, Bugeja P, Crowe H, Challacombe B, Costello AJ: A randomized trial of photoselective vaporization of the prostate using the 80-W potassium-titanyl-phosphate laser vs transurethral prostatectomy, with a 1-year follow-up. BJU Int 2010;105:964-969.
24.
Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG: Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 2010;58:384-397.
25.
Ruszat R, Seitz M, Wyler SF, Abe C, Rieken M, Reich O, Gasser TC, Bachmann A: GreenLight laser vaporization of the prostate: single-center experience and long-term results after 500 procedures. Eur Urol 2008;54:893-901.
26.
Te AE, Malloy TR, Stein BS, Ulchaker JC, Nseyo UO, Hai MA, Malek RS: Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first united states multicenter prospective trial. J Urol 2004;172:1404-1408.
27.
Kahlmeyer A, Volkmer B: How can the coding quality in the DRG system be determined? (In German). Urologe A 2014;53:33-40.
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