Laser technologies in surgery for benign prostate hyperplasia

Abstract

Introduction. Benign prostatic hyperplasia (BPH) is a multifactorial and widespread problem of modern medicine, which has not only medical but also social significance. The presence of lower urinary tract symptoms (LUTS) in men has a negative impact on the quality of life. One of the modern surgical methods for treating BPH is the use of laser technologies.Objective. To compare the effectiveness and safety of laser technologies using the example of the use of diode and thulium lasers in BPH surgery.Materials & methods. The study included 89 men with BPH who underwent surgery from 2020 to 2022. Patients were divided into two groups: in group 1 (n = 37) photoselective vaporization of the prostate was performed using a Diode Laser Vaporization of the Prostate (DiVAP), in group 2 (n = 52) - Thulium Laser Enucleation of the Prostate (ThuLEP). To assess the results of treatment, we studied indicators of maximum urine flow, residual urine volume, prostate volume, prostate-specific antigen level, severity of LUTS (IPSS scale) and symptoms of erectile dysfunction (IIEF-5 scale), level of quality of life (QoL index) and the frequency of postoperative complications. The outcomes were assessed at baseline and 3, 6, 12 months after the procedure. The duration of the operation, the duration of catheterization and the length of stay of patients in the hospital were also recorded.Results. At a long-term follow-up (12 months), the effectiveness of DiVAP and ThuLEP was comparable in terms of prostate volume (24.0 and 24.3 cm3), PSA level (3.3 and 3.4 ng/ml) and quality of life of patients related to urination (2.3 and 2.0 points). The severity of LUTS one year after treatment was also comparable in the groups (4.1 and 4.6 points), however, the IPSS scale scores was more favorable in the ThuLEP group at three- and six-month follow-up points (3 months: 14.9 and 10.0 points; 6 months: 9.3 and 7.5 points). At the same time, ThuLEP also turned out to be more effective in the rate of maximum urine flow achieved after a year (15.2 and 25.8 ml/s), the residual urine volume (8.2 and 2.2 ml), and IIEF-5 questionnaire score (22, 4 and 24.4 points), DiVAP - by operation time (58.5 and 84.6 minutes) and catheterization duration (26.8 and 32.5 hours). There were no statistically significant differences in the duration of hospitalization (2.2 and 2.1 days). Postoperative complications are recorded 2 times more often with DiVAP than after ThuLEP.Conclusions. The study confirmed the high efficiency of endoscopic laser enucleation (ThuLEP) and laser vaporization (DiVAP) technologies. The safety of ThuLEP is due to the lower incidence of postoperative complications compared to DiVAP. The success of laser operations directly depends on careful selection of patients, as well as the experience of the surgeon.