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GreenLight XPS for treating benign prostatic hyperplasia (update of MTG29)

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2 The technology

Technology

2.1 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 photoselective vaporisation.

2.2 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.

2.3 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.

Care pathway

2.4 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:

2.5 Other surgical approaches include:

Innovative aspects

2.6 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.

Intended use

2.7 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.

Costs

2.8 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