Are Outcomes of Thulium Laser Enucleation of the Prostate Different in Men Aged 75 and Over? A Propensity Score Analysis

Castellani, Daniele; Pirola, Giacomo Maria; Gasparri, Luca; Pucci, Michele; Rosa, Mirko Di; Carcano, Giulio; Saredi, Giovanni; Dellabella, Marco

doi:10.1016/j.urology.2019.06.025

Cited by 24 publications

(30 citation statements)

References 26 publications

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“…Piao et al (2016) [65] controlled the effect of HoLEP in patients classified according to their age (50-59, 60-69, 70-79, and ≥80 years), and maintained that HoLEP was a safe and effective treatment for BPH among the elderly, since postoperative complications were similar in all groups, and in 6-month postoperatives, there were no significant differences in IPSS, quality of life, Qmax, and PVR among the groups (p > 0.05). Castellani et al (2019) [66] maintained the same opinion, observing the effect of ThuLEP in patients under and above 75 years. The functional outcomes, as well as the complications postoperatively, were comparable among the two groups.…”

Section: Elderly Patientsmentioning

confidence: 62%

Lasers in Transurethral Enucleation of the Prostate—Do We Really Need Them

Herrmann

Gravas²,

Rosette

et al. 2020

JCM

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The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.

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Section: Elderly Patientsmentioning

confidence: 62%

Lasers in Transurethral Enucleation of the Prostate—Do We Really Need Them

Herrmann

Gravas²,

Rosette

et al. 2020

JCM

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“…Castellani et al compared the outcomes of ThuLEP in men aged ≥75 years vs < 75 years in a retrospective study including 412 men. 14 They observed no statistically significant difference in median operation times and LOS (p=0.452, p = 0.547; respectively) between groups. There were no differences in IPSS, Qmax, QoL, or reoperation rate between groups at the 1-year follow up.…”

Section: Resultsmentioning

confidence: 87%

“…Table 1 presents a summary of baseline characteristics, perioperative data, and the main findings of the studies included in our review. Eight of them were retrospective 14–21 and 4 prospective. 6 , 22–24 Five studies focussed mainly on Holmium laser enucleation of the prostate (HoLEP).…”

Section: Resultsmentioning

confidence: 99%

“… 6 , 22–24 Five studies focussed mainly on Holmium laser enucleation of the prostate (HoLEP). 6 , 17 , 20–22 One study focussed on comparing HoLEP to other laser prostatectomy procedures, 16 two studies examined Thulium laser enucleation of the prostate (ThuLEP) in more detail, 14 , 18 and two other studies focussed on the GreenLight XPS 180-W laser procedure, 19 , 23 one focussed on potassium-titanyl-phosphate (KTP) laser 24 and another compared laser prostatectomy to transurethral resection of the prostate (TURP). 15 …”

Section: Resultsmentioning

confidence: 99%

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Safety and Efficacy of Laser Enucleation of the Prostate in Elderly Patients – A Narrative Review

Yılmaz¹,

Esser²,

Suárez-Ibarrola³

et al. 2022

CIA

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Benign prostatic hyperplasia (BPH) is a common health condition in aging men resulting in lower urinary tract symptoms (LUTS) and low quality of life (QoL). We aimed to review studies on laser enucleation of the prostate (LEP) due to LUTS in elderly patients (>65 years) comparing different age groups, particularly considering functional outcomes, safety, and perioperative complications. A comprehensive search was conducted using the PubMed-MEDLINE, Web of Science, Wiley Online Library and Cochrane Library databases over the last 10 years until 7 October 2021 with the following search terms solely or in combination: “laser enucleation”, “prostate”, “laser prostatectomy”, “aging”, “elderly patients”, “older patients” and “age”. We identified 12 articles for inclusion in our analysis. Five studies focussed mainly on holmium laser enucleation of the prostate (HoLEP), one compared HoLEP to other laser prostatectomy procedures, two studies examined thulium laser enucleation of the prostate (ThuLEP), and two studies focused on GreenLight laser, one study focussed on potassium-titanyl-phosphate (KTP) laser, and another study compared laser prostatectomy to transurethral resection of the prostate (TURP). These studies showed that LEP improved IPSS, Qmax and QoL compared to baseline regardless of age; no significant difference was reported among age groups. Although ASA scores and anticoagulation/antiplatelet therapy rates are higher in elderly patients, studies revealed no significant difference in perioperative complication rates between age groups. Laser enucleation of the prostate is an effective and safe procedure in elderly patients, resulting in good functional outcomes, low morbidity, and few perioperative complications.

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“…Benign prostatic hyperplasia (BPH) is a significant health condition worldwide that affects up to 50% of men over 60 years and is clinically characterised by lower urinary tract symptoms (LUTS) (Vartak & Raghuvanshi, 2019). Until recently, transurethral resection of the prostate (TUR-P) was the first-line treatment for prostates under 80 ml, while open prostatectomy (OP) was recommended for prostate with volumes above 80 ml (Becker et al, 2018;Castellani et al, 2019). In recent years, in parallel to the advancements in laser technology, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) have come to the fore in the surgical treatment of BPH.…”

Section: Introductionmentioning

confidence: 99%

Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP

et al. 2021

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Summary Recently, with the advancements in laser technology, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) have come to the fore in the surgical treatment of benign prostatic hyperplasia (BPH). We aimed to evaluate and compare the outcomes of HoLEP and ThuLEP in patients with >100 ml prostate volume. Patients who underwent HoLEP and ThuLEP between July 2017 and March 2020 were reviewed retrospectively. The patients were divided into two groups as HoLEP (Group 1, n = 121) and ThuLEP (Group 2, n = 104). Perioperative parameters, functional outcomes, continence status, intra and post‐operative complications were compared between groups in the post‐operative 1st and 6th month. No significant difference was found in terms of total laser energy (TLE), morcellation efficiency (ME), enucleated tissue weight (ETW), complication rates (CR) and continence status of patients between both groups (p > .05). In favour of ThuLEP group, there were statistically significant differences regarding total operation time (TOT), laser efficiency (LE), enucleation time (ET) and enucleation efficiency (EE) between groups (p ≤ .05). HoLEP and ThuLEP can be used safely and effectively in prostates larger than 100 ml.

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Are Outcomes of Thulium Laser Enucleation of the Prostate Different in Men Aged 75 and Over? A Propensity Score Analysis

Cited by 24 publications

References 26 publications

Lasers in Transurethral Enucleation of the Prostate—Do We Really Need Them

Lasers in Transurethral Enucleation of the Prostate—Do We Really Need Them

Safety and Efficacy of Laser Enucleation of the Prostate in Elderly Patients – A Narrative Review

Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP

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