What is the treatment for benign prostatic hyperplasia (BPH) using a green light laser?

Green Light Laser Vaporization for Benign Prostatic Hyperplasia

GreenLight laser photoselective vaporization of the prostate (PVP) is an effective and safe surgical treatment for benign prostatic hyperplasia (BPH), offering comparable outcomes to traditional transurethral resection of the prostate (TURP) with advantages of reduced bleeding risk, shorter catheterization time, and shorter hospital stays. 1, 2

Mechanism and Technology

• GreenLight laser uses a 532 nm wavelength that is strongly absorbed by oxyhemoglobin in prostatic tissue
• Available in different power systems:
  • 80-W potassium titanyl phosphate (KTP)
  • 120-W lithium triborate (LBO) High Performance System (HPS)
  • 180-W LBO XPS system (most current)
• The laser energy vaporizes prostatic tissue while simultaneously sealing blood vessels

Efficacy and Outcomes

• Provides equivalent improvements to TURP in:
  • International Prostate Symptom Score (IPSS)
  • Quality of life (QoL)
  • Maximum urinary flow rate (Qmax)
  • Post-void residual (PVR) 1, 3, 2
• Benefits are durable with stable improvement reported up to 36 months 3
• The GOLIATH study demonstrated non-inferiority of 180-W XPS GreenLight laser compared to TURP at two-year follow-up 1

Advantages Over Traditional TURP

• Shorter catheterization time (many patients catheter-free at discharge)
• Reduced hospital stay (often performed as outpatient procedure)
• Lower risk of bleeding complications
• No risk of TUR syndrome (water intoxication)
• Can be safely used in patients on anticoagulation therapy 1, 2, 4

Prostate Size Considerations

• Effective for various prostate sizes, including large prostates (>100 ml)
• For larger prostates (>80 ml):
  • Requires longer operative time and more energy delivery
  • May have higher retreatment rates if inadequate energy density is delivered
  • Remains a viable alternative to TURP, HoLEP, or open prostatectomy 5

Complications and Considerations

• Lower perioperative complications compared to TURP 1
• Ejaculatory dysfunction rate comparable to TURP (approximately 50%) 1
• Potential complications include:
  • Urinary tract infections (reported in about 4.7% of patients) 3
  • Temporary dysuria or urgency
  • Rarely: urethral stricture or bladder neck contracture
• Reoperation rate after 180-W XPS laser comparable to TURP, but higher after 120-W HPS laser (11% vs 1.8%) 1

Patient Selection

• Ideal for patients with:
  • Moderate-to-severe BPH symptoms who have failed medical therapy
  • High surgical risk (elderly, comorbidities)
  • Anticoagulation therapy that cannot be discontinued
  • Desire for shorter catheterization and hospital stay 4

Comparison with Other Laser Technologies

• While HoLEP may provide more complete relief of obstruction for prostates >30g with lower long-term reoperation rates 6, GreenLight PVP offers:
  • Shorter learning curve for surgeons
  • Excellent hemostasis
  • Comparable symptomatic improvement in the short to intermediate term

Conclusion

GreenLight laser PVP represents an effective surgical option for BPH that balances good clinical outcomes with reduced morbidity compared to traditional TURP. It is particularly valuable for high-risk patients and those on anticoagulation therapy, with the 180-W XPS system showing the most favorable long-term outcomes among the GreenLight technologies.