Study of risk factors of early reintervention after prostate laser photovaporization using Greenlight 180 W-XPS

INTRODUCTION: Greenlight laser prostate photovaporization (PVP) is an alternative treatment for benign prostatic hyperplasia. However, compared to standard techniques such as transurethral resection of the prostate (TURP) and holmium laser prostate enucleation, it has certain limitations with respect to reintervention rates. The aim of our study was to identify the risk factors for reintervention due to recurrent obstruction within 12months following a photovaporization. METHODS: This retrospective, multicenter cohort study include patients treated with laser Greenlight 180W-XPS. The primary endpoint was the need for an early reintervention for obstruction. The identified causes for reintervention were: bladder neck sclerosis, urethral stricture, adenoma regrowth, managed by internal urethrotomy, PVP, or TURP. RESULTS: Data of 777 patients were analyzed and 32 reinterventions (4.1%) were recorded within 12months following surgery. Groups were comparable on preoperative data. The predictive factors for reintervention risk were: age (OR 0.92, 95% CI 0.88-0.96), laser usage time (OR 0.10, 95% CI 0.01-0.74), and energy delivered/prostate volume (OR 0.66, 95% CI 0.54-0.80). These factors were associated with a reduced risk of reintervention. The reduction is greater beyond an energy threshold of 4000J/mL (OR 0.10, 95% CI 0.04-0.27). CONCLUSION: PVP shows a low complication rate. Our results suggest that the energy delivered and the laser emission time are predictive of the quality of treatment. Despite uncertainties regarding this technique, our findings provide urologists with additional confidence in its use and offer predictive factors for assessing treatment's quality.