Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate

Abstract

Objective: To compare the efficacy and safety of a novel thulium fiber laser for endoscopic enucleation of the prostate with monopolar transurethral resection of the prostate in patients with smaller glands (<80 cc). Methods: A total of 51 patients underwent thulium fiber laser enucleation of the prostate, and 52 patients underwent monopolar transurethral resection of the prostate. All patients were assessed preoperatively, and at 3, 6, and 12 months postoperatively (International Prostate Symptom Score, maximum urine flow rate, International Prostate Symptom Score-quality of life). Preoperative prostate volumes and prostate-specific antigen levels were comparable (P = 0.543 and P = 0.078, respectively). The complications were graded according to the Clavien classification. Results: Mean surgery time was longer in the thulium fiber laser enucleation of the prostate group (46.6 AE 10.2 vs 39.9 AE 8.6 min, P < 0.001), while catheterization and hospital stay were greater in the transurethral resection of the prostate group (P < 0.001). At 12 months, there were no differences in functional outcomes (International Prostate Symptom Score, maximum urine flow rate). Despite comparable prostate volumes at 12 months (P = 0.864), the prostate-specific antigen level in the thulium fiber laser enucleation of the prostate group (0.5 AE 0.5 ng/mL) was lower than in the transurethral resection of the prostate group (1.1 AE 1.0 ng/mL; P < 0.001). Hemoglobin and serum sodium decrease was lower in the thulium fiber laser enucleation of the prostate group (1.01 AE 0.4 g/dL and 1.1 AE 1.1 mmol/L) than in the transurethral resection of the prostate group (1.8 AE 0.8 g/dL and 4.1 AE 1.1 mmol/L; P < 0.001). Urinary incontinence rates at 12 months were comparable (P = 0.316). Conclusions: Thulium fiber laser enucleation of the prostate with novel thulium fiber laser in patients with smaller prostate glands (<80 cc) is comparable to transurethral resection of the prostate in voiding parameters improvement and complication rates. At the same time, the technique allows for a more substantial prostate-specific antigen decrease, indicating more complete removal of adenoma.Key words: benign prostatic hyperplasia, endoscopic enucleation of the prostate, enucleation of the prostate, thulium fiber laser, transurethral resection of the prostate.

Surgical outcome of anatomical endoscopic enucleation of the prostate: A systemic review and meta‐analysis

“…These 21 trials were published between 2004 and 2019 with total 2,957 patients. The enrolled studies included the comparisons: HoLEP versus TURP ( n = 9) (Ahyai et al., 2007; Chen et al., 2013; Fayad et al., 2015; Gilling et al., 2012; Gupta, Sivaramakrishna, Kumar, Dogra, & Seth, 2006; Jhanwar et al., 2017; Montorsi et al., 2004; Sun et al., 2014; Wilson et al., 2006), HoLEP versus OP ( n = 2) (Kuntz, Lehrich, & Ahyai, 2008; Naspro et al., 2006), BipolEP versus TURP ( n = 3) (Luo, Shen, Guan, Li, & Wang, 2014; Zhao et al., 2010; Zhu et al., 2013), BipolEP versus OP ( n = 4) (Chen et al., 2014; Geavlete, Stanescu, Iacoboaie, & Geavlete, 2013; Ou et al., 2013; Rao et al., 2013), ThuLEP versus TURP ( n = 1) (Yang, Wang, & Liu, 2013), ThuFLEP versus TURP ( n = 1) (Enikeev, Netsch, et al, 2019) and DiLEP versus TURP ( n = 1) (Zhang, Wang, et al, 2019). Baseline patient characteristics and the methodological quality of the 21 included trials are listed in Table 1.…”

“…A total of 15 trials reporting the post‐operative IPSS of EEP versus TURP were retrieved and analysed (Ahyai et al., 2007; Chen et al., 2013; Enikeev, Netsch, et al, 2019; Fayad et al., 2015; Gilling et al., 2012; Gupta et al., 2006; Jhanwar et al., 2017; Luo et al., 2014; Montorsi et al., 2004; Sun et al., 2014; Wilson et al., 2006; Yang et al., 2013; Zhang, Wang, et al, 2019; Zhao et al., 2010; Zhu et al., 2013).…”

“…Thulium fibre laser is a new energy source applied in endourology and gains growing interests in the field of stone and BPH surgery (Traxer & Keller, 2019). Its efficacy is recently evaluated in a RCT comparing the functional and perioperative outcomes of ThuFLEP with those of TURP (Enikeev, Netsch, et al, 2019). It revealed that while ThuFLEP had longer operation time, it was associated with less complications and faster convalescence.…”

“…It revealed that while ThuFLEP had longer operation time, it was associated with less complications and faster convalescence. At 12‐month follow‐up, there was no statistical difference in the functional outcomes (IPSS, QoL, PVR, Qmax) (Enikeev, Netsch, et al, 2019). In one retrospective study compared ThuFLEP with OP, ThuFLEP was associated with equivalent functional outcomes (IPSS, Qmax, PVR) but more favourable perioperative parameters, including less haemoglobin drop, short catheterisation time and shorter length of hospital stay (Enikeev, Okhunov, et al, 2019).…”

Experimental ex-vivo performance study comparing a novel, pulsed thulium solid-state laser, chopped thulium fibre laser, low and high-power holmium:YAG laser for endoscopic enucleation of the prostate

“…Holmium:YAG lasers, thulium:YAG lasers, lithium triborate (LBO) crystal lasers, potassium-titanyl-phosphate (KTP) lasers (GreenLight laser system) and diode lasers have been the most often employed laser devices in the surgical treatment of lower urinary tract symptoms (LUTS) caused by BPH [ 2 ]. The chopped thulium fibre laser (TFL) and pulsed Tm:YAG solid-state laser (p-Tm:YAG) evaluation model used in our study are recent innovations that have the potential to play a larger role in the clinical practice of laser energy-based enucleation; they may even replace currently standard laser systems [ 3 , 4 ]. During the enucleation process, prostate adenoma is detached from the surgical pseudocapsule using laser energy and usually blunt dissection.…”