EURURO Vol. 72 No. 4

However, I think it is important not to consider the GreenLight

laser as a fall back option for high-risk patients only. Small

to mid-size prostate glands can be treated effectively with

transurethral laser vaporization in all patients. The clinical

data gathered over the last years as well as my own clinical

experience demonstrate that the GreenLight laser may offer

advantages for all patients requiring a safe and effective pro-

cedure that allows for a fast recovery compared to TURP.

Alternatively, if patients have large prostates and are not taking

anticoagulants, we use holmium laser for transurethral enu-

cleation at our clinic, because this approach offers the most

effective and long-lasting treatment outcomes in younger

patients with large prostates. As the transurethral enucleation

of the prostate with thulium lasers, this approach offers the

possibility for an adequate histological diagnosis made from

the tissue, but is generally more invasive and is associated

with an increased risk for transient incontinence among

patients at the age of 80 or older.

2,3

What clinical evidence exists for GreenLight? How did

GreenLight compare toTURP in the GOLIATH trial?

GOLIATH is the first and largest prospective randomized trial

to date comparing GreenLight laser vaporization to TURP in

281 patients across nine European countries, with a two year

follow-up period. Firstly, GOLIATH demonstrated the clinical

non-inferiority of GreenLight compared toTURP.

Secondly, no

significant differences were recorded in functional outcomes

such as urinary flow, international prostate system score

(IPSS) or prostate volume reduction. Thirdly, GOLIATH

showed the added benefit of GreenLight regarding shorter

catheterization and hospital stay, at 22 hours (compared to

46.7 hours with TURP) and 49.3 hours (versus 78.2 hours

with TURP) respectively.

Although the randomized setting of GOLIATH did not

allow a direct comparison between GreenLight and TURP for

specifically high-risk patients, the added benefit for high-risk

patients would presumably be even more significant than

shown in the study, due to GreenLight’s excellent hemosta-

sis and the less strenuous nature of the procedure. This is

also the rationale behind the clinical practice at our depart-

ment to also assign younger, low-risk patients to GreenLight,

since they too benefit from a shorter catheterization time

and a faster return to health.

What is the main advantage of GreenLight in your eyes?

The GreenLight laser gives urologists the control to address

the needs of patients with BPO, with equivalent clinical

outcomes to TURP, but fewer serious adverse events and a

shorter recovery time. The key difference in my opinion is

the excellent hemostatic and coagulation effect we see with

GreenLight procedures, which also facilitates post-operative

care.

Results from the GOLIATH study demonstrated fewer

complications and reoperations with GreenLight, with an

early re-intervention rate three times lower than after TURP

within the first 30 days post-operation.

Additionally, the

reduction in post-operative irrigation fluid compared to TURP

rendered the recovery period more comfortable for both the

patient and nursing staff. All this contributed to a less stren-

uous post-surgery care regime and reinforced GreenLight’s

status as a state-of-the-art treatment option in the field of

BPO in my opinion.

How important are sustained patient outcomes and how

can technical innovations contribute to these?

The 180W GreenLight Laser System contains significant

technical advances in comparison to the earlier 120W and

80W models. The most important new feature is the cooling

cap which protects the fiber from devitrification and maintains

optimum power delivery, thereby enabling us to remove more

tissue than before in a short period of time. The GOLIATH

study demonstrated an equal level of tissue removal with

GreenLight as with TURP. It is this ability to remove as much

tissue as possible which is decisive for improved long-term

functional outcomes, so the assumption is that results for

Greenlight will at least be equally sustained as those with

TURP, based on the currently available two-year follow-up data.

How much training is required to utilize GreenLight?

In my experience 30 to 40 procedures should generally be

sufficient to perform the operation safely. Physicians may

initially be slower or more cautious in the amount of tissue

they remove but this improves over time. The fact that the

procedure is generally very safe with a low bleeding risk

allows urologists to learn applying the new technique quickly.

In fact, GreenLight could potentially be quicker to master

than TURP, since the superior hemostasis lessens urologists’

concerns regarding bleeding or other intra- or post-operative

complications.

References

Roehrborn, C. G. Benign Prostatic Hyperplasia: An Overview. Reviews in

Urology 2005; 7(Suppl 9): 3-14.

Elshal A. M. et al. Transurethral lasere surgery for benign prostate hyperplasia

in Octogenerians: Safety and Outcomes. Urology 2013; 81: 634-639.

Nam J. K. et al. Risk factors for transient urinary incontinence after holmium

laser enucleation of the prostate. World Journal of Men’s Health 2015; 33(2):

88-94.

Thomas, J. A. et al. A Multicenter Randomized Noninferiority Trial Comparing

Greenlight-XPS Laser Vaporization of the Prostate and Transurethral Resec-

tion of the Prostate for the Treatment of Benign Prostatic Obstruction: Two-yr

Outcomes of the GOLIATH Study. European Urology 2016; 69(1): 94-102.

Bachmann, A. et al. 180-W XPS Greenlight laser vaporisation versus trans-

urethral resection of the prostate for the treatment of benign prostatic

obstruction: 6-month safety and efficacy results of a European multicentre

randomised trial – The GOLIATH study. European Urology 2014; 65(5): 931-

942

All trademarks are the property of their respective owners.

CAUTION:The law restricts these devices to sale by or on the order of a physician. Indi-

cations, contraindications, warnings and instructions for use can be found in the product

labelling supplied with each device. Information for use only in countries with applicable

health authority registrations. Material not intended for use in France.

Products shown for INFORMATION purposes only and may not be approved or for sale in

certain countries. Please check availability with your local sales representative or customer

service.

URO-489810-AA AUG 2017