How I Do It: GreenLight XPS 180W photoselective vaporization of the prostate

The treatments for benign prostate enlargement (BPE), also known as lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH-LUTS), have evolved significantly over recent years. Where transurethral resection of the prostate (TURP) has been the gold standard surgery for enlarged prostate glands < 80 grams, newer modalities such as laser technology have proliferated with safe and efficacious results. Notably, for prostates larger than 80-100 grams, the surgical options were an open, simple prostatectomy or perhaps a staged TURP. Both of these surgeries have the potential for bleeding complications, electrolyte abnormalities, and prolonged hospital admissions. Additional demographic and healthcare forces are also at play. Our aging population of men is being increasingly successfully treated for cardiovascular disease. This means more men are on anti-coagulation therapy, many of whom must stay on these drugs to prevent stent clotting or stroke. Hospital resources, especially overnight hospital admissions do add considerable strain to our healthcare systems. Men are also increasingly becoming more savvy consumers when it comes to their health. Many male patients would prefer to take as few medications as possible. Studies of BPH medications in Europe and the United States have shown drug discontinuation rates between 58%-70% at 1 year. Men who are faced with the choice of daily medication for life versus an outpatient procedure will often opt for the latter, which is in keeping with AUA guidelines that still put surgery as a patient choice alongside medications. Being able to offer GreenLight photoselective vaporization (GL-PVP) with the GreenLight XPS 180Watt system addresses all of these concerns. Men with bothersome BPH-LUTS with essentially any sized prostate gland, can be treated as same-day surgery requiring no overnight admission to hospital, while continuing necessary anti-coagulants, with significantly diminished risks of bleeding, erectile dysfunction, TUR-syndrome. Just as there are many ways to perform a TURP, techniques for GL-PVP do vary. The objectives of this article are to breakdown some of the basic steps for the novice user of GL-PVP, as well as impart some 'pearls' for the more experienced user. Nothing can replace hands-on experience for any surgery. The GL-PVP is unique in that there are guides such as this and previous articles, an excellent simulation device (GreenLight SIM), and mentoring programs in place. The success of many surgeries has been the standardization of the procedure. Performing GL-PVP should not be haphazard. A surgical plan based on prostate anatomy and size, cystoscopic appearance, and application of routinized techniques should yield consistent and optimal surgical outcomes.