MP01-18: GreenLight Photovaporization of the Prostate in High-Medical-Risk Patients: An analysis of the Global GreenLight Group (GGG) database

David-Dan Nguyen*, Claudia Deyirmendjian, Kyle Law, Naeem Bhojani, Montreal, Canada, Dean Elterman, Toronto, Canada, Bilal Chughtai, New York, NY, Franck Bruyere, Centre Val de Loire, France, Luca Cindolo, Giovanni Ferrari, Modena, Italy, Carlos Vasquez-Lastra, Mexico City, Mexico, Tiago Borelli-Bovo, Sao Paulo, Brazil, Edgardo Becher, Buenos Aires, Argentina, Hannes Cash, Magdeburg, Germany, Maximillian Reimann, Berlin, Germany, Enrique Rijo, Barcelona, Spain, Vincent Misrai, Toulouse, France, Kevin Zorn, Montreal, Canada

Introduction: Previous analyses of the safety and effectiveness of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients were limited by their small sample size and the ability to adjust for important confounders. We sought to characterize the adjusted outcomes of GreenLight PVP in 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. 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. 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. Pre-operatively, HMR patients had greater PVR and worse QoL. 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 93.1ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6–152.6, p<0.01). PSA and Qmax change did not differ significantly between both study arms.

Conclusions: We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease. 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.

Source of Funding: No funding or other financial support was received.