GreenLight XPS 180W vs HPS 120W laser therapy for benign prostate hyperplasia: a prospective comparative analysis after 200 cases in a single-center study

Objective: To evaluate the safety, efficacy, and short-term outcomes of the new GreenLight XPS (GL-XPS) 180W laser system (AMS, Minnetonka, MI) in comparison to the former generation GL-HPS 120W system for the treatment of benign prostatic hyperplasia (BPH) in a prospective nonrandomized single-center study.

Methods: From June 2010 to March 2012, 200 consecutive patients with lower urinary tract symptoms secondary to BPH were included: 80 patients were treated with GL-HPS 120W and 120 with GL-XPS 180W laser vaporization of the prostate. Perioperative variables (International Prostate Symptom Score [IPSS], quality f life [QOL], maximum flow rate (Qmax), post-void residual (PVR), and Sexual Health Inventory for Men (SHIM) were recorded at baseline, 3 months, and 6 months. Serum prostate-specific antigen (PSA) was assessed at baseline and 6-month follow-up.

Results: Patient preoperative characteristics were comparable, all P <.05. Mean operating room time (43 vs 79 minutes) and mean laser time (22 vs 37 minutes) were significantly shorter for the GL-XPS group (both P <.01) and mean energy delivery was comparable (226 vs 268 kJ, P = .21), GL-XPS vs GL-HPS. Mean fiber use (1.0 vs 1.5) and 3L saline bags (4.1 vs 7) were significantly lower with GL-XPS, all P <.01. There were no significant differences in the 30-day complication rate. To date, no urethral strictures and 1 GL-HPS retreatment were observed. PSA reduction at 6 months was significantly greater with GL-XPS (54% vs 79%, P <.01).

Conclusion: Both GreenLight systems provide safe, effective, tissue vaporization with significant clinical relief of BPH obstruction. The GL-XPS 180W system seems to be more favorable with regard to reduced operative time, fiber use, and PSA-reduction, suggesting more cost-effective and efficient tissue removal.