Comparison of urinary incontinence following three different prostate apex disconnection techniques in transurethral thulium laser prostatectomy.

OBJECTIVE: This study investigates the incidence of urinary incontinence following transurethral thulium laser prostatectomy with three different prostate apex disconnection techniques: semi-separation, pre-separation, and post-separation. The findings aim to provide references for clinical treatment. PATIENTS AND METHODS: A retrospective analysis was conducted on 74 patients treated with transurethral thulium laser prostatectomy for prostatic hyperplasia from April 2022 to March 2023. Complete clinical and follow-up data were available for 52 patients. Clinical and follow-up data were collected for these patients. A comparison was made of urinary incontinence following the three different types of prostate apex disconnection in transurethral thulium laser prostatectomy. RESULTS: In this study, the immediate postoperative urinary incontinence rate for transurethral thulium laser prostatectomy was 9.62% (5/52), the short-term incontinence rate was 11.54% (5/52), and the long-term incontinence rate was 9.62% (5/52). The immediate postoperative incontinence rates for semi-separation, pre-separation, and post- separation were 8.33% (1/12), 8.33% (2/24), and 12.5% (2/16), respectively. The short-term incontinence rates for semi-separation, pre-separation, and post-separation were 8.33% (1/12), 8.33% (2/24), and 18.75% (3/16), respectively. The long-term incontinence rates for semi-separation, pre-separation, and post-separation were 8.33% (1/12), 8.33% (2/24), and 12.5% (2/16), respectively. CONCLUSIONS: The incidence of urinary incontinence following transurethral thulium laser prostatectomy was lower with semi-separation and pre-separation compared to post-separation.

Propensity score-matched analysis comparing perioperative, functional, and safety outcomes between thulium fiber laser and bipolar enucleation of the prostate performed by a single surgeon with two years of follow-up.

PURPOSE: To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (ThuFLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis. MATERIALS AND METHODS: Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release. RESULTS: Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar. CONCLUSIONS: ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia.

A randomized trial of holmium laser vs thulium laser vs bipolar enucleation of large prostate glands.

OBJECTIVE: To compare the outcome and morbidity of bipolar transurethral enucleation of the prostate (B-TUEP) and thulium laser enucleation of the prostate (ThuLEP) with those of holmium laser enucleation of the prostate (HoLEP) in the treatment of large symptomatic benign prostatic obstruction (BPO) through a non-inferiority randomized controlled trial (NCT03916536). PATIENTS AND METHODS: A total of 155 patients were recruited from a single centre between February 2019 and August 2020. All had BPO, with a prostate volume ≥80 ml. Patients were randomly assigned to HoLEP, ThuLEP or B-TUEP using computer-generated random tables in a 1:1:1 ratio. Participants, investigators and surgeons were blinded to group assignment until the date of the operation. Thereafter, the patients were followed up at 1, 3, 6 and 12 months. The primary outcome was maximum urinary flow rate (Qmax ) at 6 months. Secondary outcomes included assessment of other functional urinary variables, peri-operative records, and adverse events. RESULTS: There were 138 and 120 patients available for analysis at 6 and 12 months. There was no significant difference in Qmax between the groups at 6 and 12 months (P = 0.4 and P = 0.7, respectively), and no significant difference regarding International Prostate Symptom Score (IPSS), quality of life (QoL) or postvoid residual urine volume (PVR). The median (interquartile range) prostate-specific antigen (PSA) reductions (ng/ml) were similar in the three groups at last follow-up point (4.7 [2.2-7.1]; 5.6 [2.3-9.5] and 5 [3.4-10] after HoLEP, ThuLEP and B-TUEP, respectively). Differences in enucleation time, enucleation efficiencies and auxiliary manoeuvres were statistically insignificant (P = 0.1, 0.8 and 0.07, respectively). At 1 year, patients with prostate volumes >120 ml showed significant IPSS improvement in favour of HoLEP and ThuLEP (P = 0.01). Low- and high-grade adverse effects were recorded in 31 and five cases, respectively, with no statistically significant difference between the groups. CONCLUSIONS: We conclude that ThuLEP and B-TUEP are as safe and effective as HoLEP for the treatment of large-sized BPO. Significant PSA reductions indicate that there was effective adenoma enucleation with all three approaches. The study provides objective evidence that endoscopic enucleation of the prostate is a technique rather than energy dependent procedure.

[Comparison of efficacy and safety of transurethral thulium laser vapoenucleation of prostate and transurethral thulium laser enucleation of prostate in the treatment of benign prostatic hyperplasia].

Objective: To compare early outcomes between transurethral thulium laser vapoenucleation of prostate and transurethral thulium laser enucleation of prostate for the treatment of benign prostatic hyperplasia (BPH). Methods: Retrospective analysis was conducted on the clinical data of 1 638 BPH patients admitted to the Department of Urology of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021. There were 916 patients underwent transurethral thulium laser vapoenucleation of prostate (ThuVEP group) and 722 patients underwent transurethral thulium laser enucleation of prostate (ThuLEP group). The operation time, eliminated tissue weight, surgical complications, duration of post-operative catheter implantation were compared between the two groups. The improvement of International Prostate Symptom Score (IPSS), Quality of Life Index (QoL), maximum uroflow rate (Qmax) and post-void residual urine volume (PVR) at 1 month after operation was compared between the two groups. Results: There were no significant differences in age, preoperative and 1-month postoperative prostate volume, IPSS score, QoL score, Qmax, and PVR between the ThuVEP and ThuLEP group (all P>0.05). There were no significant differences in perioperative indicators such as operation time, cutting or enucleation time, tissue crushing time, tissue weight, hemoglobin change, catheter indwelling time, and postoperative hospital stay between ThuVEP group and ThuLEP group (all P>0.05). The incidence of minor gross hematuria after extubation in the ThuVEP group was 7.8% (56/916), which was lower than 9.4% (65/722) in the ThuLEP group (P=0.026); the incidence of temporary incontinence at 1 month after surgery was 5.2% (38/916) in ThuVEP group, lower than 11.9% (86/722) in ThuLEP group (P<0.001). A total of 3 patients (0.4%) in ThuLEP group required operative intervention for severe post-operation bleeding, but none of ThuVEP group suffered from this kind of surgical complications. Conclusions: ThuVEP has similar efficacy with ThuLEP for the treatment of BPH. ThuVEP can significantly reduce the incidence of post-operation temporary urine incontinence, and has much superiority in stanching bleeding.

Pulsed-wave vs Continuous-wave Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP): A Comparison of Perioperative Outcomes.

OBJECTIVE: To compare intra and early postoperative outcomes between pulsed-wave and continuous-wave Thulium Fiber Laser Enucleation of the Prostate (PW-ThuFLEP vs CW-ThuFLEP) for the treatment of benign prostatic hyperplasia. METHODS: 238 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent PW-ThuFLEP (118 patients) vs CW-ThuFLEP (120 patients). Preoperative prostate volume, adenoma volume, prostate-specific antigen (PSA), and hemoglobin values were recorded. International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual volume, and International Index of Erectile Function-5 score (IIEF-5) were assessed. Operative time, enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin drop, and postoperative complications were recorded. Micturition improvements and sexual outcomes were evaluated 3months after surgery. RESULTS: CW-ThuFLEP showed shorter operative time (61.5 vs 67.4 minutes, P = .04). Enucleation time (50.2 vs 53.3 minutes, P = .12), enucleation efficiency (0.8 vs 0.7 g/min, P = .38), catheterization time (2.2 vs 2.1days, P = .29), irrigation volume (32.9 vs 32.8L, P = .71), hospital stay (2.8 vs 2.6days, P = .29) and hemoglobin drop (0.38 vs 0.39 g/dL, P = .53) were comparable. No significant difference in complication rate was observed. At 3-month follow-up, the procedures did not show any significant difference in IPSS, Qmax, post-void residual volume, IIEF-5, and PSA value. CONCLUSION: PW-ThuFLEP and CW-ThuFLEP both relieve lower urinary tract symptoms equally, with high efficacy and safety. Operative time was significantly shorter with CW-ThuFLEP, but with a small difference with low clinical impact. Enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin and PSA drop, complication rate, and sexual outcomes showed no differences.

Safety profile of treatment with greenlight versus Thulium Laser for benign prostatic hyperplasia.

OBJECTIVE: The major strengths of surgical treatment of benign prostatic hyperplasia with laser are reduced morbidity compared to endoscopic resection. No studies analysed the different risk of intra/peri-operative events between patients undergoing Thulium and GreenLight procedures. MATERIALS AND METHODS: We retrospectively reviewed 100 consecutive cases undergoing GreenLight vaporization and Thulium procedures performed during the learning curve of two expert endoscopic surgeons. Pre-operative data, intra and post-operative events at 90 days were analysed. RESULTS: Patients on antiplatelet/anticoagulant therapy were pre-dominant in the Green group (p < 0.0001). Rates of blood transfusion (p < 0.0038), use of resectoscope (p < 0.0086), and transient stress urinary incontinence were statistically higher in the Thulium group. On the contrary conversions to TURP (p < 0.023) were more frequent in GreenLight patients. Readmissions were more frequently necessary in GreenLight group (24%) vs. Thulium group (26.6%). The overall complication rate in GreenLight and Thulium groups were 31% and 53% respectively; Clavien 3b complications were 13% in Thulium patients versus 1% in GreenLight patients. CONCLUSIONS: GreenLight and Thulium treatments show similar safety profiles. Randomized controlled trial are needed to better clarify the rate of major complications in Thulium group, and the incidence of post-operative storage symptoms in these patients' populations.

Thulium Fiber Laser Enucleation of the Prostate: Prospective Study of Mid- and Long-Term Outcomes in 1328 Patients.

Objective: The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). Materials and Methods: We analyzed patients who underwent ThuFLEP due to lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, postvoid residual (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen level, and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization, and data on hospital stays were also collected. A subgroup analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. Results: A total of 1328 patients were included in the analysis. The mean age was 66.9 ± 7.5 years. Mean prostate volume was 86.9 ± 41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p < 0.05) and showed durable improvement up to 3 years of follow-up. The frequency of late complications was as follows: stress urinary incontinence-1.2%; urethral stricture-1.1%; and bladder neck contracture-0.9%. Subgroup analyses revealed increased urinary tract infection frequency in older patients (3.5% vs 0.8%, p = 0.003) as well as higher rate of stress urinary incontinence (0.4% vs 1.8%, p = 0.002) and higher rate of clot retention (11.3% vs 4.4%, p < 0.001) in those with larger glands. Conclusions: Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be a promising alternative to holmium laser enucleation of the prostate for treatment of LUTS associated with BPO.

Intraoperative and postoperative outcomes of thulium laser enucleation versus bipolar resection in the transurethral treatment of benign prostatic hyperplasia: a meta-analysis.

To compare the intraoperative and postoperative outcomes of thulium laser enucleation of the prostate (ThuLEP) vs bipolar transurethral resection of the prostate (B-TURP) in treating patients with benign prostatic hyperplasia (BPH). Clinical trials of ThuLEP and B-TURP in treating BPH were searched systematically by using PubMed, Cochrane Library databases, and EMBASE (until May 2021). The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed. The datum was calculated by Review Manager version 5.3.0. Four articles including 782 patients were studied in this analysis. The analysis discovered that there was no significant difference in operative time and percentage of tissue removed between ThuLEP and B-TURP. But the intraoperative irrigated volume and postoperative hemoglobin (Hb) decrease in the ThuLEP group was significantly less compared with the B-TURP group. The catheterization time and hospitalization duration in the B-TURP group was significantly longer than that in the ThuLEP group. Compared with those before treatment, the micturition indexes of the two groups improved significantly. But no significant difference was identified between ThuLEP and B-TURP for the variation of international prostate symptom score, quality of life, maximum flow rate, and post-void residual. By analyzing the postoperative complications, there were no significant discrepancies between ThuLEP and B-TURP in the incidence of blood transfusion, recatheterization, transient incontinence, bladder neck contracture, and urethral stricture. The micturition indexes and clinical symptoms were significantly improved after ThuLEP and B-TURP for patients with BPH. However, ThuLEP was more effective than B-TURP in terms of intraoperative irrigated volume, postoperative Hb decrease, catheterization time, and hospitalization duration.

Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate.

BACKGROUNDS: The aim of the present study was to investigate the perioperative parameters associated with bladder neck contracture (BNC) after transurethral surgery of the prostate and to compare the incidence of BNC after transurethral resection of the prostate (TURP) or Thulium vaporesection (resection group) versus Thulium vapoenucleation or enucleation of the prostate (enucleation group). METHODS: Between March 2008 and March 2020, 2363 patients received TURP and 1656 patients received transurethral surgery of the prostate with Thulium laser (ThuP) at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. A 1:1 propensity score matching model was used to evaluate the difference in incidence of BNC. RESULTS: Our study demonstrated that a greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs. 7/124, p = 0.009), coronary artery disease (14/48 vs. 16/108, p = 0.03), chronic kidney disease (14/62 vs. 11/124, p = 0.01), and two or more comorbidities (29/62 vs. 27/124, p = 0.001) compared with NBNC patients. Multivariate analysis showed that smaller prostate volume (OR 0.96 (0.94-0.99), p = 0.008) and recatherization (OR 5.6 (1.02-30.6), p = 0.047) were significantly associated with BNC. A ROC curve predicted that a prostate volume < 42.9 cm3 was associated with a notably higher rate of BNC. The propensity score matching model reported there was no difference in incidence between resection and enucleation groups. CONCLUSION: This study demonstrated that incidence of BNC was the same in different surgical techniques and that low prostate volume, recatherization and ≥ 2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.

Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP.

INTRODUCTION: The BPH surgical armamentarium is composed of a rapidly expanding number of technologies and techniques. These include greenlight photovaporization of the prostate (PVP), greenlight enucleation of the prostate (GreenLEP), holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP) and, more recently, the aquablation procedure. To the best of our knowledge, no direct comparison in operative time has been performed. METHODS: Data for this study were pooled from five sources. For aquablation, patient-level data from four studies of the aquablation procedure were provided by the device manufacturer as well as from a high-volume commercial user. PVP, GreenLEP, HoLEP, and ThuLEP were performed by high-volume, experienced experts. Endpoints included total operative time, resection time, and proportion of total operative time for resection. General linear models were used to evaluate the relationship between prostate volume (or other continuous predictors) and procedure time. RESULTS: Total procedure time was related to prostate size. Except for the small prostate size range (size < 40 cc), at any given prostate volume, procedure time was highest for PVP, intermediate for LEPs, and lowest for Aquablation. The relationship between procedure time and prostate size (i.e., slope of the fitted lines) was 0.16 min/g for aquablation, 0.32 min/g, 0.28 min/g and 0.32 min/g for GreenLEP, HoLEP and ThuLEP, respectively, and 0.63 min/g for PVP. CONCLUSION: In our analysis of pooled data of multi-surgical techniques and technologies, aquablation provided the lowest operative time across all prostate volumes. PVP had the longest procedure time for prostates > 40 cc.

Are Outcomes of Thulium Laser Enucleation of the Prostate Different in Men Aged 75 and Over? A Propensity Score Analysis.

OBJECTIVE: To evaluate the outcomes of thulium laser enucleation of the prostate (ThuLEP) in men aged ≥75 years compared to youngers. Traditional surgery has increased and significant morbidity in older men. Lasers have been introduced as an alternative approach to overcome the morbidity of traditional surgery. MATERIAL: We retrospectively evaluated 412 men who underwent en bloc ThuLEP. Inclusion criteria were lower urinary tract symptoms refractory to medical therapy, maximum urinary flow rate (Qmax) ≤15 mL/s, International Prostate Symptom Score (IPSS) ≥8 and absolute indications for surgery. Prostate volume, prostate specific antigen, IPSS, and Qmax, antiplatelet/anticoagulant therapy, ASA score, operation time, length of catheterization, discharge day, early complications, and reoperations were gathered. Differences between groups were estimated using propensity scores, by fitting a stepwise logistic regression model with age group as the dependent variable. RESULTS: One hundred twenty-nine patients were aged ≥75 years (Group 2). Mean age was 65.6 ± 6.0 years in Group 1 and 79 ± 3.7 years in Group 2. Propensity scores retrieved 206 patients. Median operation, catheterization time, and hospital stay were similar in both groups (55 minutes, 2 and 3 days). Overall, 85.9% of men had no complications, with no differences between the groups (82.5% in Group 1 and 89.3% in Group 2). The incidence of Clavien grade III-IV complications was comparable (3.8% in Group 1, 1% in Group 2). By 1 year, there were no statistically significant differences in IPSS, Qmax, QoL, or reoperation rate between the groups. CONCLUSION: En bloc ThuLEP is a safe and effective treatment even in men aged ≥75 years old.

Thulium vapoenucleation of the prostate (ThuVEP) for prostates larger than 85 ml: long-term durability of the procedure.

The purpose of this prospective study of 90 consecutive patients is to assess the long-term durability of ThuVEP in patients with benign prostatic hyperplasia (BPH) and prostate volumes ≥ 85 ml. Ninety patients with prostates ≥ 85 ml underwent ThuVEP between 2008 and 2010 at our institution. Patient demographics and short-term and long-term follow-up were evaluated. Maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), quality of life (QoL), complications, and PSA were assessed at follow-up. Median age at surgery was 71 (66-75.25) years. Thirty-seven (41.1%) of the patients were in urinary retention at the time of surgery. Prostate volume was 100 (88-122) ml. Median follow-up was 36.5 (16-60) months. At 12-month follow-up, IPSS, QoL, Qmax, and PVR had improved significantly compared with preoperative assessment and continued to do so during follow-up (p < 0.001). At 4-year postoperative, median Qmax (19.1 vs. 7.75 ml/s), PVR (31.9 vs. 150 ml), IPSS (4.5 vs. 24), and QoL (1 vs. 5) differed significantly from baseline (p ≤ 0.027). PSA decreased from 7.4 (4.14-14) to 0.70 (0.36-1.64) µg/l (p < 0.001) at 48-month follow-up, corresponding to a PSA reduction of 86.48% (79.85-95.25%). Urinary tract infections occurred in 2 (2.2%) patients. Urethral stricture and bladder neck contracture developed in 1 (1.1%) patient each. One patient (1.1%) had recurrent adenoma of the prostate and was treated with thulium vaporesection of the prostate. ThuVEP is a durable modern alternative to open prostatectomy for patients with substantially enlarged prostates due to BPH. The incidence of complications with ThuVEP during long-term follow-up was low.

Transurethral thulium laser enucleation versus resection of the prostate for treating benign prostatic hyperplasia: a retrospective study.

This study aimed to compare the clinical outcomes between transurethral thulium laser enucleation of the prostate (ThuLEP) and transurethral thulium laser resection of the prostate (ThuLRP) for treating benign prostatic hyperplasia (BPH). From May 2014 to August 2015, 212 patients underwent ThuLRP and 188 patients underwent ThuLEP. The ThuLEP group was further divided into two subgroups according to the ways the prostate was taken out. The perioperative parameters were recorded and analyzed. The international prostate symptom score (IPSS), quality-of-life (QoL) score, maximum flow rate (Qmax), and postvoid residual urine volume (PVR) in both groups were estimated and compared 3, 6, and 12 months after surgery. No significant difference was observed between the groups in terms of irrigated time, irrigated volume, catheterization time, and hospital stay. However, the significantly lower hemoglobin drop was observed in the ThuLRP group compared with the ThuLEP group. The ThuLEP group with a morcellator required a shorter operation time for patients with large prostate volume (> 60 mL) compared with the ThuLRP and ThuLEP groups without a morcellator. During 12 months of follow-up, IPSS, Qmax, QoL, and PVR improved significantly without significant differences between the groups. No severe complications were reported; however, the occurrence of transient urge incontinence was higher after ThuLEP compared with ThuLRP, and the proportion of urinary tract infection after surgery was higher in ThuLRP than in ThuLEP. ThuLRP and ThuLEP are safe and efficient for treating patients with symptomatic BPH. ThuLRP offers advantages in terms of minimal blood loss.

A Feasibility Study Utilizing the Thulium and Holmium Laser in Patients for the Treatment of Recurrent Benign Prostatic Hyperplasia after Previous Prostatic Surgery.

BACKGROUND: Transurethral resection of the prostate (TURP) is considered to be the standard treatment for patients with benign prostatic obstruction (BPO) ≤80 mL. However, up to 14.7% of the patients require secondary TURP due to recurrent BPO. The aim of our study was to describe specific features of holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) in patients with recurrent BPO after previous prostate surgery. MATERIALS AND METHODS: A total of 768 consecutive patients from our prospective collected database were retrospectively reviewed and divided into 4 groups: group A (489 patients) and group C (253 patients) underwent primary HoLEP and ThuLEP treatment, while group B (17 patients) and D (9 patients) included patients with recurrent BPO who were treated with HoLEP and ThuLEP, respectively. RESULTS: There were no significant differences in preoperative parameters between the groups at primary (A and C) and secondary (B and D) treatment except their age. At 6-month follow-up, voiding parameters and symptom scores showed statistically significant improvements compared to baseline without differences between the groups. The mean operative time was comparable between the groups and did not differ significantly (p > 0.05). CONCLUSIONS: Laser enucleation for the treatment of recurrent BPO is feasible and seems to be a safe and effective procedure.

Thulium (Tm:YAG) laser vaporesection of prostate and bipolar transurethral resection of prostate in patients with benign prostate hyperplasia: a systematic review and meta-analysis.

Thulium laser vaporesection (ThuVARP) and bipolar transurethral resection of the prostate (B-TURP) are novel surgeries for benign prostate hyperplasia (BPH). This paper is a systematic review and analysis of literatures comparing efficacy indicators, operative parameters, as well as safety indicators between ThuVARP and B-TURP for the treatment of BPH. A systematic search of electronic databases, including PubMed, the Cochrane Library, Web of Science, Embase, and China National Knowledge Internet (CNKI), was carried out up to December 1, 2015 (updated on March 1, 2016). The captivating outcomes included basic clinical characteristics, perioperative parameters, local complications, and efficacy indicators which included International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR). After assessing the quality of methodology and extracting data, a meta-analysis was carried out by using STATA 12.0 software. Five studies involving 500 patients met the standard. The outcomes of this analysis were as follows: (a) efficacy indicators: there were no significant differences in IPSS, QoL, PVR, and Qmax between the two groups (all P > 0.05); (b) perioperative indicators: ThuVARP had longer operative time [standardized mean difference (SMD) = 0.843; 95% confidence interval (CI) - 0.391, 1.296; P < 0.001] but less serum hemoglobin decreased (SMD = - 0.561; 95% CI - 0.796, - 0.327; P < 0.001), shorter hospital stay (SMD = - 1.558; 95% CI - 2.709, - 0.407; P < 0.01), and catheterization time (SMD = - 1.274; 95% CI - 2.158, - 0.390; P < 0.01). Additionally, no significant difference was found in estimated resected weight (P > 0.05); (c) safety indicators: no significant difference was found in local complication rates (all P > 0.05) between ThuVARP and B-TURP. In our analysis, there exists no statistical difference between ThuVARP and B-TURP group in efficacy. However, in spite of requiring longer surgical time, ThuVARP was better in terms of less blood loss as well as shorter hospitalization and catheterization time.

[Thulium laser vaporization versus transurethral resection of the prostate and risk factors for postoperative urethral stricture].

OBJECTIVE: To compare thulium laser vaporization of the prostate (TLVP) and transurethral resection of the prostate (TURP) in the treatment of benign prostate hyperplasia (BPH) analyze the risk factors for postoperative urethral stricture. METHODS: From June 2015 to June 2016, 210 BPH patients in our hospital underwent TURP (n = 126) or TLVP (n = 84). We followed up the patients for 6 months, compared the effects of the two surgical strategies and analyzed the risk factors for postoperative urethral stricture by multivariate logistic regression analysis. RESULTS: Compared with TURP, TLVP achieved significantly shorter time of operation (ï¼»78.6 ± 27.5ï¼½ vs ï¼»53.2 ± 21.6ï¼½ min, P <0.01), postoperative bladder irrigation (ï¼»31.5 ± 2.9ï¼½ vs ï¼»26.1 ± 3.7ï¼½ h, P <0.01), urethral catheterization (ï¼»5.3 ± 1.7ï¼½ vs ï¼»3.7 ± 1.5ï¼½ d, P <0.01) and postoperative hospitalization (ï¼»7.9 ± 2.1ï¼½ vs ï¼»5.5 ± 1.4ï¼½ d, P <0.01) as well as lower urinary leukocyte count at 6 months after surgery (ï¼»32.1 ± 12.6ï¼½ vs ï¼»24.9 ± 11.7ï¼½ /µl, P <0.01) and incidence rate of postoperative complications (11.9% ï¼»15/126ï¼½ vs 3.6% ï¼»3/84ï¼½, P <0.05), particularly that of urethral stricture (7.9% ï¼»10/126ï¼½ vs 1.2% ï¼»1/84ï¼½, P <0.05). Logistic regression analysis showed that the preoperative urinary leukocyte count, postoperative urethral catheterization time, and surgical method were independent risk factors for postoperative urethral stricture. CONCLUSIONS: TLVP, in comparison with TURP, has the advantages of definite effect, fast recovery, high safety and low incidence of postoperative urethral stricture. The main risk factors for postoperative urethral stricture include preoperative urinary tract infection, postoperative urethral catheterization time and surgical method.

One day surgery in the treatment of benign prostatic enlargement with thulium laser: A single institution experience.

PURPOSE: Various articles have previously addressed the introduction of new surgical laser therapies for an enlarged prostate gland causing obstructive symptoms. The objective of this study was to report the feasibility of performing the thulium laser vapo-enucleation of the prostate (ThuVEP) procedure for benign prostatic obstruction in a 1-day surgery. MATERIALS AND METHODS: From September 2011 to September 2013, we conducted a prospective study on patients who underwent ThuVEP in a 1-day surgery. The primary outcomes measured perioperatively included operative time, resected tissue weight, hemoglobin decrease, transfusion rate, postoperative irrigation and catheterization time, and postoperative hospital stay. Also, the preoperative and postoperative International Prostate Symptom Score (IPSS) and results of uroflowmetry performed on the 7th and 30th postoperative days were recorded. All perioperative and postoperative complications were monitored. RESULTS: A total of 53 patients underwent the surgical treatment in a 1-day surgery. Seven patients continued antiaggregant therapy with aspirin. Mean preoperative prostatic adenoma volume was 56.6 mL. Mean operative time was 71 minutes. The average catheter time was 14.8 hours. The peak urinary flow rate on day 7 improved from 9.3 to 17.42 mL/s (p<0.001) and the IPSS improved from 18 to 10.2 (p<0.01). Patients were routinely discharged on the day of catheter removal. No complications were recorded. CONCLUSIONS: ThuVEP can be safely conducted as a 1-day surgical procedure. This strategy results in cost savings. ThuVEP shows good standardized outcomes with respect to improvement in flow parameters and length of bladder catheterization.

Are Histological Findings of Thulium Laser Vapo-Enucleation Versus Transurethral Resection of the Prostate Comparable?

We investigated if an adequate histological diagnosis can be made from tissue after Thulium laser vapo-enucleation of the prostate (ThuVEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with symptomatic benign prostatic hyperplasia. We analyzed 350 ThuLEP and 100 matched TURP tissue specimens from patients who underwent one of the two procedures between January 2009 and June 2014. Thulium Laser Enucleation of Prostate (ThuVEP) was combined with mechanical morcellation of the resected lobe. Each histological specimen was reviewed by two pathologists. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups (2.5 % in the ThuVEP group versus 3 % in the TURP group). Tissue thermal artifacts induced by the Thulium laser are mostly due to coagulation as that of the conventional monopolar diathermy in TURP. Tissue quality was maintained in the ThuVEP histological specimens. Tissue maintain histological characteristics and proprieties without modification for successive immunoistochemical analysis. The pathologist ability to detect incidental prostate cancer and PIN was maintained even if there is a quoted of vaporized tissue.

One day surgery in the treatment of benign prostatic enlargement with thulium laser: A single institution experience

PURPOSE: Various articles have previously addressed the introduction of new surgical laser therapies for an enlarged prostate gland causing obstructive symptoms. The objective of this study was to report the feasibility of performing the thulium laser vapo-enucleation of the prostate (ThuVEP) procedure for benign prostatic obstruction in a 1-day surgery. MATERIALS AND METHODS: From September 2011 to September 2013, we conducted a prospective study on patients who underwent ThuVEP in a 1-day surgery. The primary outcomes measured perioperatively included operative time, resected tissue weight, hemoglobin decrease, transfusion rate, postoperative irrigation and catheterization time, and postoperative hospital stay. Also, the preoperative and postoperative International Prostate Symptom Score (IPSS) and results of uroflowmetry performed on the 7th and 30th postoperative days were recorded. All perioperative and postoperative complications were monitored. RESULTS: A total of 53 patients underwent the surgical treatment in a 1-day surgery. Seven patients continued antiaggregant therapy with aspirin. Mean preoperative prostatic adenoma volume was 56.6 mL. Mean operative time was 71 minutes. The average catheter time was 14.8 hours. The peak urinary flow rate on day 7 improved from 9.3 to 17.42 mL/s (p<0.001) and the IPSS improved from 18 to 10.2 (p<0.01). Patients were routinely discharged on the day of catheter removal. No complications were recorded. CONCLUSIONS: ThuVEP can be safely conducted as a 1-day surgical procedure. This strategy results in cost savings. ThuVEP shows good standardized outcomes with respect to improvement in flow parameters and length of bladder catheterization.

High-power thulium laser vaporization of the prostate: short-term outcomes of safety and effectiveness.

INTRODUCTION: The thulium laser was introduced in 2005 for the treatment of benign prostatic hyperplasia (BPH). Enucleation studies from outside North America show comparable efficacy and lower morbidity to transurethral resection of the prostate. A few studies exist describing outcomes of vaporization, the most commonly used technique for urologists. We present our 3-month outcomes of thulium laser vaporization of the prostate (ThuVP). MATERIALS AND METHODS: From December 2010 to October 2013, 68 men underwent ThuVP using the 150 W CyberTM(®). Data were collected on demographics, comorbidities, intraoperative measures, complications, serum parameters, maximum flow rate (Qmax), postvoid residual (PVR), International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, and prostate-specific antigen. Patients were evaluated at 1 week, 1 month, and 3 months postoperatively. Nine patients were excluded for known prostate cancer. RESULTS: The mean age was 66±10 years, with a mean prostate size of 57±30 mL. At baseline, the mean IPSS was 19.9±8.0, QoL score was 4.5±1.1, Qmax was 5.2±4.5 mL/sec, and PVR was 220±397 mL. The mean laser time was 35±18 minutes, and energy used was 234±139 kJ. Forty-seven (78%) patients were discharged the day of surgery. No blood transfusions were administered with a mean drop in hemoglobin of 0.7±0.8 g/dL (p<0.05). There were no Clavien grade≥III complications within 30 days of surgery. Six (10%) patients were diagnosed with urinary tract infection. Significant improvements from baseline were seen in Qmax, PVR, IPSS, and QoL score. All 15 patients who were in retention were voiding at the last follow-up. CONCLUSIONS: Thulium laser vaporization of the prostate appears to be a safe and effective outpatient technique for the treatment of BPH with durable outcomes at 3 months.