Safety and efficiency of thulium laser prostate resection for the treatment of benign prostatic hyperplasia in large prostates

Abstract

Thulium laser resection of the prostate-tangerine technique (TmLRP-TT) dissects whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. The present study aimed to evaluate the safety and efficacy of TmLRP-TT for older symptomatic benign prostatic hyperplasia patients with large prostates during 18 months of follow-up. A prospective analysis of 95 consecutive patients with large prostates (>80 ml) who underwent surgical treatment using TmLRP-TT was carried out. All patients were evaluated preoperatively and at 1, 6, 12, and 18 months postoperatively by the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Q max), postvoid residual urine volume (PVR), International Index of Erectile Function 5 (IIEF-5), urine analysis, and urine culture. Perioperative complications were recorded and graded by the modified Clavien classification system (CCS). Mean preoperative prostate volume was 106.81 ± 24.79 ml. TmLRP-TT was successfully completed in all patients. The mean operative duration, catheterization time, and hospital stay were 95.36 ± 27.06 min, 2.25 ± 0.9 days, and 5.39 ± 1.18 days, respectively. The decrease in mean hemoglobin level was 1.23 ± 0.72 g/dl, and that in mean serum sodium level was 0.71 ± 2.56 mmol/l. Within the observation period of 18 months, the patients showed an improvement in IPSS (20.01 ± 7.08 vs. 4.96 ± 3.68), QoL (4.10 ± 1.16 vs. 1.23 ± 1.30), Q max (8.14 ± 3.81 ml/s vs. 18.33 ± 2.56 ml/s) and PVR (102.70 ± 70.64 ml vs. 20.28 ± 30.02 ml), compared with baseline values (P < 0.001). IIEF-5 remained stable. Minor complications occurred in 10 (10.52 %) of 95 patients (Clavien grade 1, 9.47 % and grade 2, 1.05 %). There were no severe complications requiring reintervention (Clavien grade 3, 0 % and grade 4, 0 %). TmLRP-TT is a safe and effective surgical endoscopic technique associated with a low complication rate in large prostates as assessed during an 18-month follow-up period. It is a promising technology, which may be considered as one of the alternatives to open simple prostatectomy (OP) for large prostates in the future.

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate: A Retrospective Bicentric Matched-Paired Comparison with 24-Month Follow-Up

“…In this series, voiding parameters (Qmax, PVR) and symptom scores (IPSS, QoL) were significantly improved after ThuVEP and ThuVaRP at 12- and 24-month follow-up, in line with the current HoLEP [2, 3, 7], PVP [2, 3], and TURP [2-4, 6, 9, 11, 15, 22, 23] literature and well-comparable to former ThuVEP [7, 8, 17, 18] and ­ThuVaRP [4, 6, 9-14, 22, 24-26] series. However, at 24-month follow-up, Qmax and PVR were significantly different between ThuVEP and ThuVaRP, while no differences were found between the groups with regard to IPSS and QoL.…”

“…In accordance with the low Hb decrease, the rate of postoperative blood transfusions was low and not different between both groups (1.3%) and in line with the HoLEP [2, 3], PVP [2, 3], ThuVaRP [4, 6, 9-14, 22-26], and ThuVEP [7, 8, 16-18] literature. One explanation for the differences in Hb decrease in our series might be a larger surface of the pseudocapsule of the prostate after ThuVEP compared to ThuVaRP.…”

“…The perioperative Hb decrease was significantly higher after ThuVEP compared to that after ThuVaRP (0.9 vs. 0.4 g/dL), but the Hb decrease after ThuVEP in our series is well comparable to the Hb decrease in the ThuVaRP (0.8–0.92 g/dL) group [9, 12, 23, 26] and ThuVEP literature [16-18]. In accordance with the low Hb decrease, the rate of postoperative blood transfusions was low and not different between both groups (1.3%) and in line with the HoLEP [2, 3], PVP [2, 3], ThuVaRP [4, 6, 9-14, 22-26], and ThuVEP [7, 8, 16-18] literature.…”

“…Due to the retrospective non-randomized approach, a selection bias based on primary detrusor failure due to long-lasting BPO in the ThuVEP group cannot be excluded completely, since pressure flow studies have not been performed preoperatively. Although significant differences in Qmax and PVR were found in our study, the clinical relevance is questionable, since the Qmax and PVR values in our series at 12- and 24-month follow-up after ThuVEP are well comparable with the TURP [2-4, 6, 9, 11, 15, 22, 23], HoLEP [2, 3], PVP [2, 3], ThuVaRP [4, 6, 9-14, 22, 24-26] and ThuVEP [7, 8, 17, 18] literature.…”

“…These RR are similar to HoLEP [2, 3, 27], TURP [2, 3, 27], PVP [2, 3, 27], and ThuVEP [8, 17, 24] series. RR ranging from 1.3 to 2.1% for bladder neck contractures [12, 13, 24], from 2.1 to 3.5% for urethral strictures [11-13, 25, 26] and from 1.2 to 2.6% for regrowth of prostatic tissue [12, 14] have been reported for ThuVaRP at 24-month follow-up. Due to lesser tissue removal with the ThuVaRP procedure in our study, one would expect a higher RR for regrowth of prostatic tissue with a longer follow-up.…”