Are Histological Findings of Thulium Laser Vapo-Enucleation Versus Transurethral Resection of the Prostate Comparable?

Abstract

We investigated if an adequate histological diagnosis can be made from tissue after Thulium laser vapo-enucleation of the prostate (ThuVEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with symptomatic benign prostatic hyperplasia. We analyzed 350 ThuLEP and 100 matched TURP tissue specimens from patients who underwent one of the two procedures between January 2009 and June 2014. Thulium Laser Enucleation of Prostate (ThuVEP) was combined with mechanical morcellation of the resected lobe. Each histological specimen was reviewed by two pathologists. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups (2.5 % in the ThuVEP group versus 3 % in the TURP group). Tissue thermal artifacts induced by the Thulium laser are mostly due to coagulation as that of the conventional monopolar diathermy in TURP. Tissue quality was maintained in the ThuVEP histological specimens. Tissue maintain histological characteristics and proprieties without modification for successive immunoistochemical analysis. The pathologist ability to detect incidental prostate cancer and PIN was maintained even if there is a quoted of vaporized tissue.

Safety and Efficacy of Thulium Laser Prostatectomy Versus Transurethral Resection of Prostate for Treatment of Benign Prostate Hyperplasia: A Meta‐Analysis

“…A total of 36 articles were searched, 29 of which were excluded after screening their titles and abstracts. One trial was excluded after reading the full text, because the trial was reported in abstract. Finally, six studies were included in this systematic meta‐analysis, including three randomized controlled trials (RCT), one quasi‐ randomized control trial (Q‐RCT) and two case control studies (CCS) (Fig.…”

Current evidence of ThuLEP for BPH: A review of literature

“…The reduced resected tissue weight can be attributed to the quote of vaporized tissue that is lost for final weighing when using the thulium laser. Despite this quote of vaporized tissue, Carmignani et al 36 showed that histological features of tissue specimens from ThuVEP are preserved, and that the detection rate of incidental prostatic adenocarcinoma was comparable to TURP. ThuEP, TURP, and PKRP do not seem to significantly impair EF; however, two studies suggested that ThuEP could lead to mild improvement, possibly due to the reduced thermal damage of the laser compared to TURP.…”

Meta‑analysis of the effect of antithrombotic drugs on perioperative bleeding in BPH surgery

“…Four studies (27)(28)(29)(30) reported photoselective vaporization of the prostate (PVP). Thulium laser vaporesection of the prostate (ThuVARP) was used as surgical methods in 2 studies (31,32) and 1 study (21) reported thulium laser enucleation of the prostate (ThuLEP). The quality assessment of the included studies is shown in Table II. TURP: Persistent-usage group vs. discontinued group.…”