Thulium:YAG VapoEnucleation of the prostate in large glands: a prospective comparison using 70- and 120-W 2-µm lasers

Abstract

This study compared the efficacy of 70-and 120-w 2-mm thulium:YAG VapoEnucleation of the prostate (ThuVEP) for patients with benign prostatic obstruction (BPO). A prospective analysis of 84 patients with symptomatic BPO and prostatic enlargement (o60 ml) who underwent either 70-w (n544) or 120-w ThuVEP (n540) non-randomly was carried out. Patient demographics and perioperative and 12-month follow-up data were analysed. The mean prostate volume was 79.90627.49 ml in patients who had received 70-w ThuVEP, which was less than in those who had received 120-w ThuVEP (88.53625.10; P50.033). ; P50.000) and percentage of resected tissue (66.93%622.79% vs. 45.41%623.33%; P50.000) were higher with 120-w treatment compared to 70-w ThuVEP. One patient (1.2% of total patients) (in the 120-w group) required a blood transfusion postoperatively. Sixty-one patients (73%) were available for review at the 12-month follow-up time point. The quality of life (QoL), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q max ), postvoiding residual urine (PVR) and prostate volume improved significantly after treatment (Pf0.035) and were not significantly different between those treated with the different devices (70-and 120-w). The median prostate volume reduction was 81.70% and 82.19% with 70-and 120-w ThuVEP, respectively. The incidence of complications was low and did not differ between groups treated with the different devices. Two patients (2.4%) (one per group) had a bladder neck contracture at the follow-up. ThuVEP is a safe and efficacious procedure for the treatment of symptomatic BPO. The incidence of complications was low with both devices. The 120-w thulium:YAG device enhances the effectiveness of ThuVEP with regard to the percentage of resected tissue and the enucleation/operation efficiency.

A prospective, randomized comparison of a 1940 nm and a 2013 nm thulium: yttrium-aluminum-garnet laser device for Thulium VapoEnucleation of the prostate (ThuVEP): First results

“…At discharge, there were no differences in Qmax between the two lasers, while PVR was significantly lower in the 1940 nm laser group (0 vs. 50 mL, P ≤ 0.034). These results for PVR and Qmax in both groups were in line with previous ThuVEP series[ 7 13 14 15 ] and well comparable with TURP[ 2 3 ] and open prostatectomy[ 1 3 17 18 19 ] as well as with minimally invasive procedures like HoLEP,[ 3 20 21 22 ] PVP[ 3 23 ] or bipolEP. [ 4 5 6 ] Longer follow-up is however needed to assess differences in PVR and Qmax between the two thulium lasers.…”

“…The outcome and complications of HoLEP and the PVP procedure have been evaluated in numerous studies. [ 3 ] Transurethral prostate enucleation procedures are typically performed by bipolar energy[ 4 5 6 ] or by thulium[ 7 12 13 14 15 ] and holmium lasers. [ 3 12 ] The thulium and holmium lasers both use water as the tissue target but differ with regard to wavelength, penetration depth and the way of applying laser energy.…”

“…These slight differences in coagulation depths may have consequences for the ThuVEP procedure as the ThuVEP literature was primarily based on the use of the 2013 nm thulium laser. [ 7 13 14 15 ] We therefore report the early results of the first prospective, randomized comparison of a 1940 nm and a 2013 nm thulium laser for the ThuVEP procedure.…”

“…These complication rates are comparable with other minimally invasive transurethral procedures for the treatment of BPO, like bipolEP,[ 4 5 6 ] HoLEP,[ 3 20 21 22 24 25 ] PVP[ 3 23 ] and former ThuVEP series. [ 7 13 14 15 ]…”

Best laser for prostatectomy in the year 2013

“…Overall satisfactory results were documented and ThuLEP was found to be safe and effective modality for management of BPH. The same group compared ThuLEP by 70 W and 120 W[34] and found that 120 W enhances the effectiveness of ThuLEP with regard to the percentage of resected tissue and the enucleation/operation efficiency. When comparing 120 W and 200 W units in 28 patients with 60-70 g prostate, they found equivalent safe and efficacious clinical outcomes with both units at 12-month follow-up.…”