En bloc greenlight laser enucleation of prostate (GreenLEP): about the first hundred cases

Frédéric Panthier, Jennifer Pasquier, Sébastien Bruel, Vidal Azancot, Alexandre De La Taille, Daniel Gasman

Research output: Contribution to journalArticle

Abstract

Purpose: To report the functional outcomes, perioperative morbidity and surgical learning curve key points using “en bloc” greenlight enucleation of prostate (EB-GreenLEP) for patients with refractory lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods: Between December, 2015 and May, 2018, all consecutive patients with refractory LUTS due to BPH in our institution were included and underwent EB-GreenLEP by a single surgeon. Perioperative data, complications and functional outcomes at 1-, 6- and 12-month follow-ups were collected and retrospectively analyzed. Results: One hundred patients were included whose median age was 69 years. The median prostate volume (PV) was 84 mL and median enucleated PV was 45.5 mL. Mean irrigation, catheterization and hospitalization times were 1.3, 1.4 and 1.6 days, respectively. Average follow-up was 9.3 months. A single high-grade Clavien-Dindo complication occurred. No urinary retention was reported. Two conversions to conventional resection of the prostate were noted. Three patients had postoperative urinary incontinence at 6 months, only one at 1 year (1%). At 1, 6 and 12 months, there was a significant improvement in IPSS score, QoL and Qmax. Enucleation and energy efficiency ratios were shorter after the 30th procedure. We demonstrated a linear correlation between enucleation time and PV (r = 0.53, p < 0.0001). Conclusion: Our study shows that the mid-term functional results of EB-GreenLEP are comparable to other laser sources for the endoscopic enucleation of the prostate but with a shorter learning curve. We showed that, with (a) low rates of complications and a short hospital stay, EB-GreenLEP can manage medium-size glands (60–90 mL).

Original languageEnglish
JournalWorld Journal of Urology
DOIs
Publication statusAccepted/In press - 1 Jan 2019

Fingerprint

Prostate
Lasers
Lower Urinary Tract Symptoms
Learning Curve
Prostatic Hyperplasia
Urinary Retention
Urinary Incontinence
Catheterization
Length of Stay
Hospitalization
Morbidity
Efficiency

Keywords

  • Benign prostatic hyperplasia
  • Enucleation
  • Greenlight
  • Laser
  • Learning curve
  • Prostate

ASJC Scopus subject areas

  • Urology

Cite this

En bloc greenlight laser enucleation of prostate (GreenLEP) : about the first hundred cases. / Panthier, Frédéric; Pasquier, Jennifer; Bruel, Sébastien; Azancot, Vidal; De La Taille, Alexandre; Gasman, Daniel.

In: World Journal of Urology, 01.01.2019.

Research output: Contribution to journalArticle

Panthier, Frédéric ; Pasquier, Jennifer ; Bruel, Sébastien ; Azancot, Vidal ; De La Taille, Alexandre ; Gasman, Daniel. / En bloc greenlight laser enucleation of prostate (GreenLEP) : about the first hundred cases. In: World Journal of Urology. 2019.
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abstract = "Purpose: To report the functional outcomes, perioperative morbidity and surgical learning curve key points using “en bloc” greenlight enucleation of prostate (EB-GreenLEP) for patients with refractory lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods: Between December, 2015 and May, 2018, all consecutive patients with refractory LUTS due to BPH in our institution were included and underwent EB-GreenLEP by a single surgeon. Perioperative data, complications and functional outcomes at 1-, 6- and 12-month follow-ups were collected and retrospectively analyzed. Results: One hundred patients were included whose median age was 69 years. The median prostate volume (PV) was 84 mL and median enucleated PV was 45.5 mL. Mean irrigation, catheterization and hospitalization times were 1.3, 1.4 and 1.6 days, respectively. Average follow-up was 9.3 months. A single high-grade Clavien-Dindo complication occurred. No urinary retention was reported. Two conversions to conventional resection of the prostate were noted. Three patients had postoperative urinary incontinence at 6 months, only one at 1 year (1{\%}). At 1, 6 and 12 months, there was a significant improvement in IPSS score, QoL and Qmax. Enucleation and energy efficiency ratios were shorter after the 30th procedure. We demonstrated a linear correlation between enucleation time and PV (r = 0.53, p < 0.0001). Conclusion: Our study shows that the mid-term functional results of EB-GreenLEP are comparable to other laser sources for the endoscopic enucleation of the prostate but with a shorter learning curve. We showed that, with (a) low rates of complications and a short hospital stay, EB-GreenLEP can manage medium-size glands (60–90 mL).",
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