BPH Thulium laser enucleation of the prostate (TmLEP) vs. transurethral resection of the prostate (TURP): evaluation of early results

Abstract

IntroductionThe first decade of XXI century it is a time of the thulium laser implementation to a benign prostatic hyperplasia treatment.ObjectiveThe objective of this paper is a comparative assessment of early results thulium laser enucleation of the prostate (TmLEP) versus transurethral resection of the prostate (TURP) in 3-months observation.Materials and methodsPatients were randomized to BPH surgical treatment: research group (TmLEP – 54 men) or control group (TURP – 52 men). Between 02.2007-09.2009 non-consecutive patients were examined before, one month, and 3-months after surgery. Perioperative data (age, PV, time of surgery, use of laser, morcellation, catheterization, hospitalization, used energy, Hgb loss and removed tissue weight) were assessed. Before and after surgery IPSS, QoL, Qmax and PVR were controlled.ResultsHemoglobin loss was twice lower during TmLEP than TURP [0.95 ±0.77 (0-3.2) vs. 1.81 ±0.97 (0.1-4.7) g/dl, p <0.0001]. Surgery time TmLEP was longer than TURP [102.2 ±38.7 (25-210) vs. 74.5 ±22.8 (25-140) min. p <0.0001]. Without morcellation time [28.1 ±17.9 (5-80) min.], surgery time of both procedures was comparable. Weight of resected tissue was lower in TmLEP than TURP [24.8 ±14.8 (2-65) vs. 34.8 ±14.1 (12-68)g]. without consideration of vaporized tissue. In both groups we noticed a distinct improvement in all parameters: IPSS, QoL, Qmax and PVR, but without any statistically significant differences between them. Complications after surgery were similar in TmLEP and TURP group.ConclusionsThe thulium laser enucleation of the prostate is safe and efficient BPH treatment method, comparable to the transurethral electroresection in 3-months observation. Lack of long-term research does not allow to form wider conclusions.

Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement

“…As a result, only five studies provided surgical data for analysis. The latter studies include two prospective cohorts (level of evidence IIa) and three randomized controlled trials comparing ThuLEP with TURP or HoLEP (level of evidence 1b) [6][7][8][9][10]. The study of Shao et al [8] was in Chinese, and data were extracted by the English abstract and after personal communication with the authors.…”

“…Iacono et al [6] enrolled patients with prostate volumes (PV) larger than 75 cc (median 108.08 ml), whereas Zhang et al [9] enrolled patients with PV < 80 ml (median 46.6 ml in the ThuLEP arm). In contrast, Świniarski et al [10] and Rausch et al [7] enrolled consecutive patients with PV of any size (28-126 and 17-180 ml accordingly) with a median of 62 and 85 ml for ThuLEP cases accordingly. The above heterogeneity should be taken into consideration when evaluating ThuLEP results given that prostatic volume is a well-established predictor of perioperative outcomes.…”

“…Management of enucleated prostatic lobes was also different among studies. Tissue morcellation was performed either conventionally via a mechanical tissue morcellator or with a mushroom technique [6,7,9,10]. The latter technique consists of fragmentation of the three enucleated mushroom-like pedicles (medial and lateral devascularized lobes, crowded at the bladder neck) with the use of the electrocautery loop [11].…”

“…The latter technique consists of fragmentation of the three enucleated mushroom-like pedicles (medial and lateral devascularized lobes, crowded at the bladder neck) with the use of the electrocautery loop [11]. Finally, follow-up periods varied among studies between short term (up to 3 months) and intermediate term with 12, 18 and 24 months of follow-up [6,7,9,10]. Preoperative patient's characteristics in each study are summarized in Table 1.…”

Clinical optimal dose of solifenacin succinate for�nursing patients after transurethral resection of the prostate during the perioperative period

“…Previous reports have shown that SOL is a safe and efficient treatment for patients with benign prostate hyperplasia after transurethral resection of the prostate (8,13). Reports also suggest that TURP is low risk, highly safe and associated with less complications when treating benign prostate hyperplasia (14,15). In this study, we investigated the efficacy of different dosages of SOL for patients with benign prostate hyperplasia during the perioperative period.…”