Thulium laser enucleation of prostate versus laparoscopic trans-vesical simple prostatectomy in the treatment of large benign prostatic hyperplasia: head-to-head comparison

Abstract

Objectives: To compare thulium laser enucleation of prostate (ThuLEP) versus laparoscopic trans-vesical simple prostatectomy (LSP) in the treatment of benign prostatic hyperplasia (BPH). Materials and Methods: Data of patients who underwent surgery for "large" BPH (>80mL) at three Institutions were collected and analyzed. Two institutions performed ThuLEP only; the third institution performed LSP only. Preoperative (indwelling catheter status, prostate volume (PVol), hemoglobin (Hb), Q max , post-voiding residual volume (PVR), IPSS, QoL, IIEF-5) and perioperative data (operative time, enucleated adenoma, catheterization time, length of stay, Hbdrop, complications) were compared. Functional (Q max , PVR, %ΔQ max ) and patientreported outcomes (IPSS, QoL, IIEF-5, %ΔIPSS, %ΔQoL) were compared at last follow-up. Results: 80 and 115 patients underwent LSP and ThuLEP, respectively. At baseline, median PVol was 130 versus 120mL, p <0.001; Q max 9.6 vs. 7.1mL/s, p=0.005; IPSS 21 versus 25, p <0.001. Groups were comparable in terms of intraoperative complications (1 during LSP vs. 3 during ThuLEP) and transfusions (1 per group). Differences in terms of operative time (156 vs. 92 minutes, p <0.001), Hb-drop (-2.5 vs. -0.9g/dL, p <0.001), catheterization time (5 vs. 2 days, p <0.001) and postoperative complications (13.8% vs. 0, p <0.001) favored ThuLEP. At median follow-up of 40 months after LSP versus 30 after ThuLEP (p <0.001), Q max improved by 226% vs. 205% (p=0.5), IPSS decreased by 88% versus 85% (p=0.9), QoL decreased by 80% with IIEF-5 remaining almost unmodified for both the approaches. Conclusions: Our analysis showed that LSP and ThuLEP are comparable in relieving from BPO and improving the patient-reported outcomes. Invasiveness of LSP is more significant.

Long-term functional outcomes and surgical retreatment after thulium laser enucleation of the prostate: A 10-year follow-up study

“…When enough hyperplastic tissue is removed during surgery, the prostate takes several years to redevelop and impair urinary function; therefore, only long-term studies can reliably evaluate the functional outcomes of BPH surgical treatment. In addition to time from surgery, several other factors could influence the risk of LUTS recurrence and BPH retreatment (e.g., type of surgical procedure, surgeon experience, patient age, and PV); however, the evidence available on the topic is limited (5,(16)(17)(18)(19).…”

Predictors of early catheter replacement after HoLEP. Results from a high-volume laser center

“…While current available literature reports plenty of evidence investigating the safety and efficacy of different techniques for the surgical management of BPH ( 15 ), there is far less investigation into the HoLEP field in the setting of predictors of early catheter replacement. Indeed, although the surgical technique has already reached a high standardization, we still need finer tools to timely identify those patients eventually experiencing an early failure in resuming normal micturition after surgery.…”

Prostatic arterial embolization as a micro-invasive treatment option for benign prostatic obstruction: A subtle balance between short-term follow-up patient-reported outcomes and de-obstructive effectiveness

“…Such benign prostatic obstruction (BPO) is initially treated by medical therapy. In those patients affected by LUTS refractory to medical therapy, transurethral resection of the prostate (TURP) and its laser-based transurethral enucleative alternatives have represented the gold-standard approach for decades (3,4). The issue during daily clinical practice is that patients (particularly when younger) are often reluctant to undergo transurethral "extirpative" techniques given their associated risks, the first and foremost being retrograde ejaculation (5).…”