A comparative evaluation of thulium laser enucleation versus bipolar transurethral resection of prostate in the management of large prostate (>60 g): A prospective randomized controlled trial

Abstract

Background: The prevalence of prostate enlargement increases with age in older men and is a prevalent clinical disease. The current study was conducted with the objective of comparatively evaluating the efficiency and safety of prostate resection techniques, thulium laser enucleation (ThuLEP) versus bipolar transurethral resection of prostate (TURP) for large prostate (>60 g) glands. Aims and Objective: The aim of the study was to compare result of ThuLEP versus Bipolar TURP in Large Prostate (>60 g) – A Prospective Randomized Study. Materials and Methods: In this prospective randomized controlled trial, symptomatic patients with BPH (benign prostatic hyperplasia) with a prostate gland >60 g indicated for surgery were included in the study. On the basis of the treatment, patients were grouped into Bipolar TURP and ThuLEP groups with 36 patients each. Demographics, patient characteristics, and laboratory investigations were recorded at baseline. Intraoperative parameters including operation time, blood loss, and complications were compared between groups. Uroflowmetry parameters were compared on days 7, 1, and 3 months of follow-up. Results: Baseline patient characteristics were comparable between groups. Major variation in the mean operative time (88.69 vs. 96.11 min, P = 0.002), the volume of blood loss due to capsular or sinus perforation (0.51 vs. 0.28 L, P < 0.001), mean duration of postoperative catheterization (30.50 vs. 21.26 h, P < 0.001), and a mean number of hospital stays (38.42 vs. 29.06 h, P < 0.001) was noted between Bipolar TURP versus ThuLEP group. The post-void residual urine was significantly higher in bipolar TURP vs. ThuLEP at 1 week following surgery (P = 0.042) but was similar at 1- and 3-month follow-ups. AT 3 months, the mean residual prostate volume was considerably lower in ThuLEP group than the bipolar TURP group. All related complications were comparable between groups, mild and transient in nature, and disappeared within 1 month of follow-up. Conclusion: The efficiency and safety of bipolar TURP and ThuLEP procedures for the management of large prostate are comparable. Due to the lower rate of blood loss, ThuLEP can be preferred in patients with coagulation disorders.