More than one million people over the age of 50 are affected by benign prostatic hyperplasia, which causes lower urinary tract symptoms [1] .

Several minimally invasive surgical management techniques have been developed in recent years, including prostatic photovapourisation using the GreenLight laser, which has become increasingly widespread in France. Its use rose from 0.5% of adenoma surgeries in 2005 to 23% in 2014 [2] . This has resulted in a decline in both AVH and TURP procedures [2] .

The results of prostatic photovapourisation appear to be comparable to those of TURP in terms of functional efficacy in most studies and superior to TURP in terms of morbidity, hospitalisation, and catheterisation duration [3] . It can be performed on patients at risk of bleeding, with a reduction in the likelihood of haemorrhage [4] . The TURP syndrome is virtually non-existent with photovapourisation compared to TURP [5] .

The aim of this study was to analyse the management of symptomatic benign prostatic hyperplasia via prostatic photovapourisation in the urology department of Hospital Nord Franche-Comté.

This was a single-centre, descriptive, retrospective study of patients with symptomatic or complicated benign prostatic hyperplasia (BPH) treated by prostatic vapourisation with the GreenLight laser over a one-year period, from 1 January to 31 December 2021.

All cases of BPH operated on by GreenLight laser photovaporization of the prostate during the study period, with a follow-up check-up one month after the procedure, were included.

Patients operated on by prostatic photovapourisation who had any of the following were excluded: a neurogenic bladder associated with BPH, a history of prostate surgery, an associated urethral stricture, prostate cancer, or bladder neck sclerosis.

A Wolf 26 resectoscope with 30˚ optics, including a specific laser fibre holder, continuous irrigation using isotonic saline, and free-flow return, was used for all procedures. The evacuated content was aspirated and quantified using a Tune aspirator with a capacity of 24 litres. The AMS GreenLight XPS-180 W laser generator was used in association with the MoXy laser fibre.

We conducted an exhaustive recruitment of patients who met the specified criteria. A total of 78 patients, managed by a single operator with a baseline experience of over 200 cases, were assessed preoperatively, intraoperatively, and postoperatively.

The preoperative assessment included:

Patients with elevated PSA underwent prostate MRI and biopsy, if necessary, to confirm the benign nature of the hypertrophy.

The urine cytobacteriological examination (ECBU) was performed 10 days before the operation. Positive ECBUs were treated according to the antibiogram for at least seven cumulative days before and after the procedure, with no additional tests conducted. All patients received cefazolin as a prophylactic antibiotic, in line with AFU recommendations. Anticoagulation therapy was switched to enoxaparin at a preventive dose 72 hours before the operation and continued for 10 days afterward. Acetylsalicylic acid-based antiplatelet treatment was maintained throughout the perioperative period.

The evaluation focused on the type of anaesthesia, duration of energy emission, energy delivered, volume irrigated, and volume collected. Any intraoperative incidents—such as capsular perforation, massive haemorrhage requiring conversion to monopolar or bipolar transurethral resection, or vaporisation of the meatus—were recorded.

Postoperatively, the durations of catheterisation and hospitalisation, complications classified according to the Clavien classification modified by the GreenLight Users Group (GUGL), and functional results at one month (M1) were analysed. Functional outcomes were assessed using the IPSS-Quality of Life questionnaire and debimetry (Qmax), with measurement of residual post-void volume (RPM). There was no overall reassessment of patients beyond one month due to several patients failing to attend their 3-month and 6-month appointments.

The distribution of patients according to age and preoperative characteristics is shown in Figure 1 and Table 1 , respectively.

Prostatic photovapourisation, like monopolar and bipolar resection, is a recognised option for the management of complicated prostatic hypertrophy. Because it can be performed in patients with comorbidities, it has emerged as a therapeutic alternative to TURP and upper adenomectomy (AVH) in our practice.

In this study, as in others [6] - [9] , patient age, ASA score, and prostate weight did not present barriers to GreenLight laser PVP. Functional outcomes were comparable to those of other techniques, with a marked reduction in postoperative morbidity, hospitalisation, and catheterisation time. All procedures were performed by a single surgeon with experience exceeding 200 cases—more than the 50 to 100 cases often cited as the learning curve in the literature [10] - [13] . This may partly explain the absence of intraoperative incidents and the reduced procedure time made possible by delivering higher energy levels. All patients had incomplete or complete retention despite medical therapy, which contrasts with the low IPSS scores observed in some cases.

The median energy delivered was 223.5 KJ, which in many studies [1] [2] [12] correlates with prostate weight or volume. This was not confirmed in our study, partly due to the lack of measurements of residual prostate weight or volume after PVP. The median vaporization time was 32.5 minutes with a median prostate weight of 50 g, closely aligning with the findings of Francesco Sessa et al. [12] , who reported 42 minutes with a median weight of 56.5 g.

One goal of PVP is to enable outpatient surgery. In our series, 56.41% of cases were performed on an outpatient basis, somewhat lower than the 67% - 90% rates observed elsewhere [2] [14] [15] . Hospitalisation was often recommended by anaesthetists due to comorbidities, or because patients were scheduled late during the coronavirus pandemic, when urological emergencies were occasionally integrated into the official operative programme.

Like TURP and AVH, PVP yields similarly favourable postoperative functional outcomes, including a significant reduction in IPSS, improved quality of life, and increased Qmax [3] [7] [13] [16] - [18] . In our study, the mean IPSS was 3.84, the mean Qmax was 25.55 ml/s, and the mean quality of life score was 1.28 at one month, which we consider satisfactory. The retrospective nature of the study did not allow for the assessment of sexual function due to the absence of data in patient records. As with any surgical procedure, PVP can involve complications, classified according to the Clavien-Dindo system by the GreenLight Users Group (GUGL). These complications vary and may include irritative symptoms, urinary retention after catheter removal, haematuria, infection, or, rarely, mortality. In our series, 26.92% of patients experienced complications, all of which were graded ≤2 at one month, predominantly comprising irritative symptoms. These findings are consistent with the literature [3] [6] [13] . We found no statistical correlation between complications and ASA score, the presence of preoperative retention, or anticoagulant therapy.

Prostatic photovapourisation with the GreenLight XPS 180 W laser is now a standard treatment for BPH, regardless of prostate volume or patient comorbidities. It is associated with fewer postoperative complications and is frequently feasible on an outpatient basis. Hospital stay and catheterisation times are generally brief, and functional outcomes are favourable. However, it does not allow for histological analysis due to the absence of tissue. This means that rigorous screening for prostate cancer is required before the procedure can be recommended. Further research involving larger cohorts, sexual function parameters, and extended follow-up will help elucidate the impact of PVP on sexual outcomes and the long-term stability of its functional results.

The head of the Ethics and Medical Information Committee was asked to authorize the use of the data for scientific purposes. The referral was validated, and the data were made available for the study.

We consent to the publication of the data and hereby transfer, assign, or otherwise convey all copyright ownership, including all rights therein, exclusively to the journal, in the event that such work is published by the journal.

ASA: American Society of Anesthesiologists;

AVH: Upper Adenomectomy;

BMI: Body Mass Index;

BPH: Benign Prostatic Hyperplasia;

ECBU: Cytobacteriological Examination of Urine;

GUGL: GreenLight User Group;

IPSS: International Prostate Symptom Score;

MRI: Magnetic Resonance Imaging;

PSA: Prostate-Specific Antigen;

PVP: Prostatic Photovaporisation;

RPM: Residual Post-Void Volume;

TURP: Transurethral Resection of the Prostate;

W: Watt.