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

ABSTRACT

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.