Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction

Herrmann, Thomas; Bach, Thorsten; Imkamp, Florian; Georgiou, Anastasios; Burchardt, Martin; Oelke, Matthias; Gross, Andreas J.

doi:10.1007/s00345-009-0503-0

Cited by 184 publications

(157 citation statements)

References 26 publications

Supporting

Mentioning

142

Contrasting

Unclassified

Order By: Relevance

“…Achieving a penetration depth of approximately 1 mm, this laser has been used for vaporesection, vapoenucleation and other procedures during the surgical treatment of BPH. [4][5][6][7][8][9] The PiCCO transpulmonary thermodilution hemodynamic monitoring system (PULSION Medical Systems, Munich, Germany), which uses dynamic parameters to predict fluid responsiveness, can be used for hemodynamic measurements and intravascular volume optimization. 10 These hemodynamic indices are of great utility for understanding the physiological condition of each patient and guiding fluid management.…”

Section: Introductionmentioning

confidence: 99%

Thulium laser vaporesection versus standard transurethral resection of the prostate: A randomized trial with transpulmonary thermodilution hemodynamic monitoring

Chen

et al. 2012

Int J of Urology

View full text Add to dashboard Cite

Abbreviations & AcronymsObjectives: To characterize the hemodynamics comparing thulium laser vaporesection of the prostate with traditional transurethral resection of the prostate. Methods: A total of 80 consecutive patients with benign prostatic hyperplasia were randomly assigned into the thulium laser vaporesection of the prostate group or transurethral resection of the prostate group. Transpulmonary thermodilution hemodynamic monitoring was used before and 1 h after surgery to assess patient hemodynamics. Acute complications and treatment efficiency were evaluated after surgery. Results: There were no statistical differences in age, prostate volume, anticoagulants and International Prostate Symptom Score between the two groups. The postoperative Stroke Volume Index was significantly higher in the thulium laser vaporesection of the prostate group (P = 0.007). The extravascular lung water and intrathoracic blood volume indices differed significantly pre-and postoperatively, and were similar in both groups. Decreases in serum sodium and hemoglobin concentrations after surgery were lower in the thulium laser vaporesection of the prostate group (P < 0.01). Acute complications, and improvements in International Prostate Symptom Score and maximum urinary flow rates, were similar in both groups. Conclusions: Transpulmonary thermodilution hemodynamic monitoring provides additional safety measures during surgical procedures. Thulium laser vaporesection of the prostate is associated with fewer hemodynamic changes and provides similar efficacy to transurethral resection of the prostate. Thus, it can be considered a safe and effective procedure.

show abstract

Section: Introductionmentioning

confidence: 99%

Thulium laser vaporesection versus standard transurethral resection of the prostate: A randomized trial with transpulmonary thermodilution hemodynamic monitoring

Chen

et al. 2012

Int J of Urology

View full text Add to dashboard Cite

show abstract

“…

…”

mentioning

confidence: 99%

Enucleation is enucleation is enucleation is enucleation

Herrmann

2016

World J Urol

Self Cite

View full text Add to dashboard Cite

followed in 2004 [2], then later in the end of the 2000s all other transurethral laser-based enucleation techniques: Tm:YAG Vapoenucleation (ThuVEP) [3], transurethral anatomical enucleation with Tm:YAG Support (ThuLEP) [4], diode laser enucleation of the prostate (DiLEP) [5] and finally Lithium-Borate "Greenlight" enucleation of the prostate (GreenLEP) [6] appeared on the market to finally replace open prostatectomy (OP) and TURP. It took Thulium:YAG as the challenger to initiate a discussion about the impact of laser in transurethral enucleation. The surgical twins "ThuVEP" and "ThuLEP" demonstrated the whole spectrum of laser action in enucleating techniques. ThuVEP focuses on the favorable vaporization effect of continuous-wave lasers to perform a fast, effective and safe enucleation, whereas ThuLEP focuses on almost blunt mechanical enucleation using the laser only for dissection of adherences and mucosa. The latter on anatomy focusing approach was mimicked by other continuous-wave lasers (LBO/"Greenlight" and 980 nm diode laser) that had not been found suitable for enucleation at the initial point of the discussion [5,6].The most famous quotation from Gertrude Stein's poem Sacred Emily "Rose is a rose is a rose is a rose." is often interpreted as "things are what they are." When reviewing all meta-analyses and structured reviews of the past 3 years, the energy source seems to be secondary and a result of resources and personal preference of a skilled surgeon, today [7]. The time has come to move from sophistical marketing of a single energy source to the overarching principle of anatomical enucleation to focus all efforts to establish enucleation as the de facto standard treatment 32 years after Hiraoka [8] laid the cornerstone for all anatomical transurethral enucleation techniques of the prostate with his monopolar transurethral detachment prostatectomy technique (TUE). Abstract The latest update of the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms, incl. Benign Prostatic Obstruction in 2016 announced a novel acronym for transurethral Endoscopic Enucleation of the Prostate (EEP). This was inspired by a meta-analysis on randomized controlled trials on HolmiumLaser Enucleation of the Prostate (HolEP) and bipolar enucleation versus open simple prostatectomy. EEP codes for the common ground of both techniques: "anatomical enucleation." Although study quality with regard to the availability of long-term randomized controlled trials is at the moment mostly available for HoLEP, and bipolar enucleation, the existing data of all other enucleating techniques that have been demonstrated to perform anatomical enucleation as well should also been summarized under the same term. This editorial is a call for embracing this acronym of EEP for all anatomical enucleating techniques in order to serve for the transition from the age of TURP and open prostatectomy toward the age of EEP. Editorial,The great merit of holmium laser enucleation of the prostate (HoLEP) is to have laid out the re...

show abstract

“…Keeping prostatic tissue in front of the laser fibre at all times during the procedure would accelerate the vaporesection. Certainly, the mode of vaporesection mentioned above differs from VapoEnucleation as reported by Herrmann et al, 10 which enucleates the whole prostate.…”

Section: Discussionmentioning

confidence: 48%

“…[9][10][11] The increase in output energy of the laser from 70 to 120 W strengthens the ability to vaporesect prostatic tissue. Bach et al…”

Section: Discussionmentioning

confidence: 99%

In vitro comparison of the vaporesection of human benign prostatic hyperplasia using 70- and 120-W 2-µm lasers

Luo¹,

Xia²,

Sun³

2011

Asian J Androl

View full text Add to dashboard Cite

The purpose of the current ex vivo study was to compare the speed of vaporesection of human prostatic tissue with benign prostatic hyperplasia (BPH) and the depth of tissue damage using 70-and 120-W 2-mm laser devices. Fresh prostatic tissue specimens were obtained from five patients by open prostatectomy, and were divided into separate groups (70 and 120 W) based on the energy of the laser output (70 and 120 W, respectively). The vaporesection speed, coagulation zone depth and the necrotic tissue layer in the prostatic tissue were evaluated. The current result showed that the speeds (mean6s.d.) of vaporesection were 5.2160.66 and 10.3961.15 g/5 min for the 70 and 120 W groups, respectively (P50.000). There was no difference in the depth of necrosis/ coagulation (0.9860.13/0.3060.09 and 0.9960.12/0.3160.08 mm) for the 70 and 120 W groups, respectively. In conclusion, both 70-and 120-W 2-mm laser devices had superficial tissue damage during the vaporesection of human prostate tissue; moreover, the 120-W laser offers a higher vaporesection speed than the 70-W laser.

show abstract

Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction

Abstract: ThuLEP offers complete removal of the transition zone no matter what prostatic size. The techniques combine maximum efficacy with minimal side-effects. Clinical results comparing ThuLEP with open prostatectomy or transurethral resection are awaited.

Cited by 184 publications

References 26 publications

Thulium laser vaporesection versus standard transurethral resection of the prostate: A randomized trial with transpulmonary thermodilution hemodynamic monitoring

Thulium laser vaporesection versus standard transurethral resection of the prostate: A randomized trial with transpulmonary thermodilution hemodynamic monitoring

Enucleation is enucleation is enucleation is enucleation

In vitro comparison of the vaporesection of human benign prostatic hyperplasia using 70- and 120-W 2-µm lasers

Contact Info

Product

Resources

About