180 W vs 120 W Lithium Triborate Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia: A Global, Multicenter Comparative Analysis of Perioperative Treatment Parameters

ObjectiveTo evaluate the surgical performance of the new Greenlight XPS-180W laser system (American Medical Systems, Minnetonka, MI) and the effect of prostate volume (PV), in comparison with the former HPS-120W system, for the treatment of benign prostatic hyperplasia by photo-selective vaporization of the prostate.MethodsBetween July 2007 and March 2012, 1809 patients underwent laser photo-selective vaporization of the prostate (1187 patients with the use of HPS-120W and 622 patients with the use of XPS-180W) at 7 international centers. All data were collected prospectively. Comparative analysis was performed between XPS and HPS according to PV measured by transrectal ultrasound.ResultsThe XPS compared with HPS, allowed significantly reduced laser and operative time (29.6 minutes vs 65.8 minutes and 53 minutes vs 80 minutes, respectively; P <.01 for both). The number of fiber used during the procedures was significantly reduced with the XPS system (1.11 vs 2.28; P <.01), whereas total energy delivered was lower (250.2 kJ vs 267.7 kJ; P = .043). Overall, the mean operative time, mean laser time, and mean energy were all significantly increased according to PV >80 mL vs <80 mL. However, when stratified according to PV, XPS demonstrates significant advantages compared with HPS, regardless of prostate size in all operative parameters (P <.01).ConclusionThe new XPS-180W system exhibits significant advantages in all surgical parameters compared with the HPS-120W system. Overall, with XPS-180W and HPS-120W, mean operative time, laser time, and energy usage increased according to PV. This suggests that preoperative evaluation of PV by transrectal ultrasound should be mandatory.