Trends in the Use of the GreenLight Laser in the Surgical Management of Benign Prostatic Obstruction in France Over the Past 10 Years.

Photoselective vaporization of the prostate (PVP), introduced in the late 1990s, is now considered a valuable alternative to transurethral resection of the prostate (TURP) [1]. Although several studies conducted in Asia and North America have highlighted the expanding role of laser prostatectomy [2,3], specific epidemiological data in Europe are critically lacking. We describe the trends in the surgical management of benign prostatic obstruction (BPO) in France over the past 10 yr, with a specific focus on the use of the GreenLight laser. We analyzed data from a national comprehensive administrative claim database (previously described by Lukacs et al [4]) to estimate the number of endoscopic procedures (whatever the technique) and open prostatectomy surgeries performed each year between 2005 and 2014. We concurrently analyzed data from the manufacturer regarding use of the GreenLight laser fibers (American Medical Systems, Minnetonka, MN, USA) in France during the same period. PVP numbers were subtracted from the group of endoscopic procedures. Because enucleation was introduced in France only very recently, the remaining endoscopic procedures were hereafter designated as TURP. For the 2014 figures, data were extrapolated from those obtained for the period from January to September. The overall number of BPO surgical procedures in France remained stable during the study period (61 993 in 2005 and 60 184 in 2014). During the past decade, the share of PVP has dramatically increased from 0.2% in 2005 to 22.9% of all procedures in 2014, whereas the number of TURPs and open prostatectomies conducted per year decreased from 52 828 to 40 436 and from 9069 to 5948 (34.4% reduction), respectively (Fig. 1A). In 2014, TURP, open prostatectomy, andPVP accounted for 67.2%, 9.9%, and 22.9%, respectively, of all benign prostatic hyperplasia surgeries. The fibers used were mostly KTP 80W between 2005 and 2006, HPS 120W between 2007 and 2010, and XPS 180W between 2011 and 2014 (Fig. 1B). The increaseduse of PVP thusmainly occurred during the XPS era. Our results are consistent with previous findings outside Europe [2,3,5]. However, in 2014, the rate of TURP remained