GreenLight XPS for treating benign prostatic hyperplasia

GreenLight XPS (Boston Scientific) is a 180 W, 532 nm wavelength laser system intended to treat benign prostatic hyperplasia (BPH). It works by removing excess prostate tissue using laser vaporisation (a procedure known as photoselective vaporisation of the prostate [PVP]). A laser fibre is passed through a cystoscope to vaporise the enlarged prostate, leaving a clear urethral channel. In 'coagulation' mode, GreenLight XPS can also seal (cauterise) any bleeding vessels that may result from PVP.

The GreenLight XPS system consists of a reusable laser console and a single-use fibre optic delivery device. It uses a proprietary MoXy liquid-cooled laser fibre, which is designed to handle high power and reduce fibre degradation.

The procedure can be done either as a day case or on an inpatient basis. It is carried out under general or spinal anaesthetic. Using GreenLight XPS requires training, and the NHS has a mentorship scheme.

Current surgical treatment for BPH when conservative management has been unsuccessful, or is not appropriate, is in NICE's guideline on managing lower urinary tract symptoms in men and includes:

• monopolar or bipolar transurethral resection of the prostate (TURP). See NICE's medical technologies guidance on the PLASMA system for transurethral resection and haemostasis of the prostate

• transurethral vaporisation of the prostate (TUVP)

• holmium laser enucleation of the prostate (HoLEP)

• transurethral incision of the prostate (TUIP; only in prostates smaller than 30 ml)

• open prostatectomy (only in prostates larger than 80 ml).

Other surgical approaches include:

• prostatic urethral lift (see NICE's medical technologies guidance on UroLift for treating lower urinary tract symptoms of benign prostatic hyperplasia)

• PLASMA (see NICE's medical technologies guidance on the PLASMA system for transurethral resection and haemostasis of the prostate)

• water vapour thermal therapy (see NICE's medical technologies guidance on Rezum for treating lower urinary tract symptoms secondary to benign prostatic hyperplasia)

• photoselective laser vaporisation techniques.

GreenLight XPS uses a proprietary MoXy laser fibre, which is actively cooled using a flow of saline to improve fibre durability. Because the laser operates at a shorter wavelength (532 nm) than other laser systems, it is absorbed by oxyhaemoglobin, vaporising the tissue without leaving fragments behind. GreenLight XPS can also seal (cauterise) any bleeding vessels which result from PVP in 'coagulation' mode.

GreenLight XPS is intended for PVP to treat BPH. It is contraindicated for people with prostate cancer. For a full list of contraindications and details on using GreenLight XPS, see the instructions for use.

The company said that it usually provides the GreenLight XPS laser to the NHS for free, as part of a contractual arrangement in which the NHS agrees to buy a minimum number of laser fibres over a specified time period at an average price of £500 per fibre (excluding VAT). The company also said that if more than 1 fibre is needed per person, it will provide it for free.

For more details, see the webpage for GreenLight XPS at the Boston Scientific website.