Thulium Laser for treatment of benign prostatic hyperplasia in large prostate.

Stefano Mattioli1, Alessandro Picinotti1, Andreina Burgio1
  • 1 Centro Chirurgico Toscano Sezione Urologia Laser (Arezzo)

Objective

Laser technologies for benign prostatic hyperplasia (BPH) have steadily replaced transurethral resection of the prostate (TURP) and open prostatectomy (OP) over the past 10 years in many parts of the world. Techniques for laser prostatectomy used in each country vary, with enucleation preferred in some countries and vaporisation preferred in others. Perioperative complications and morbidities associated with these procedures, such as severe bleeding, the risk of fluid volume absorption and prolonged recovery, led to the development of more minimally invasive techniques to achieve comparable surgical outcome as TURP or OP.
This study is a prospective analysis of 272 patients (pts) who underwent to vapoenucleation with Thulium laser (ThuVEP) for benign prostatic hyperplasia in large glands.

Methods and results

From October 2011 to September 2013, we treated 272 pts using thulium. The preoperative assessment included evaluation of the prostate volume by suprapubic ultrasound and the post-voiding residual urine (PVR) volume by abdominal ultrasonography, a digital rectal examination, a prostate specific antigen (PSA), calculation of the IPSS. Uroflowmetry was performed in all patients except 21 pts who already had catheter. Spinal or general anaesthesia was performed. ThuVEP was conducted using the 100 or 120 Watt and it was performed by two experienced surgeons to minimize the effects of the learning curve on the surgical outcome. The procedure was performed using a 24 F continuous-flow laser resectoscope in combination with a mechanical morcellator. The enucleated tissue was histopathologically analysed in all pts. Bladder irrigation was used overnight in all cases, and the catheter was removed on the second day.
Prostatic volume range: 80-130 gr with a median prostate volume of 100 g but there were no differences in the occurrence of complications when compared with smaller prostates. Mean operative time: 72 minuts. A median of 30 g of tissue was retrieved from pts. No major complications were reported. Minor complications not requiring intervention occurred in 2,3% of pts. These included recatheterisation in 1,3% and prolonged irrigation in 1%. No patient received blood transfusions postoperatively. At follow-up of 6-12-24 mo, comparing pre and postoperative parameters (IPSS, mean QMax, PVR) we had total resolution of obstruction.

Discussion

ThuVEP is a minimally invasive, size independent, safe, and efficacious procedure for the treatment of symptomatic BPH with low perioperative morbidity. In according with Literature, in this study, the immediate improvement of obstructive voiding after ThuVEP proved to be satisfactory. Other authors assessed complications and outcomes by prostate size for ThuVEP and they found that PVR and Qmax improved significantly at discharge and were comparable with holmium laser enucleation, photoselective vaporization of the prostate, TURP and open prostatectomy and we think that ThuVEP is a procedure that should be offered to all patients with large prostates if the local expertise is available.

References

[1] Schroeck FR, Hollingsworth JM, Kaufman SR, Hollenbeck BK, Wei JT. Population based trends in the surgical treatment of benign prostatic hyperplasia. J Urol 2012;188:1837–41.
[2] Laser Enucleation Is Increasingly Becoming the Standard of Care for Treatment of Benign Prostatic Hyperplasia of All Sizes. Peter J. Gilling European Urology 63 (2013) 868-871.
[3]Complications and Early Postoperative Outcome in 1080 Patients After Thulium Vapoenucleation of the Prostate: Results at a Single Institution. Andreas J. Gross ,, Christopher Netsch , Sophie Knipper , Jasmin Holzel, Thorsten Bach. European Urology 63 (2013) 859-867
[4] Thulium:YAG VapoEnucleation of the prostate in large glands: a prospective comparison using 70- and 120-W 2-mm lasers. Christopher Netsch, Thorsten Bach, Thomas RW Herrmann and Andreas J Gross. Asian Journal of Andrology (2012) 14, 325–329.

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