Introduction & Objective :
Endoscopic enucleation of the prostate (EEP) has been recognized as a viable treatment modality for men with benign prostatic hyperplasia (BPH). The aim of our study was to compare the efficacy and functional outcomes of three different techniques of EEP including monopolar enucleation (MEP), holmium laser enucleation (HoLEP), and thulium laser enucleation (ThuLEP).
After approval by the Institutional Review Board committee, we performed retrospective assessment of pre- and postoperative parameters of 551 male patients aged 54 to 87 years. We assessed patients with urinary retention and indwelling urethral catheters or those with poor urination (IPSS>20; QmaxLumenis, Israel) with a 550 µm laser fiber. For ThuFLEP, we used thulium fiber laser Urolase (NTO IRE-POLUS, Russia) and a 600 µm fiber. Functional parameters were evaluated before treatment and six months after which included IPSS, Qmax, post-void residual volume, prostate volume, as well as sodium and hemoglobin levels.
A total of 551 men with the mean age of 67.1 years were included in the study. Of these, MEP was performed on 95 patients, HoLEP was performed on 254 patients, and ThuLEP on 202 patients. The mean mass of morcellated tissue obtained during the three techniques did not differ significantly (p > 0.05). Mean procedure times of ThuLEP and HoLEP were shorter than monopolar enucleation demonstrating 72, 76, and 86 minutes, respectively (p < 0.01). The mean catheterization time following laser EEPs was shorter than monopolar enucleation as shown by 1.3, 1.3, and 3.8 days, respectively (p < 0.01). Hospital stay times of HoLEP and ThuLEP were shorter than monopolar enucleation demonstrated by 3.3, 3.4, and 6.9 days, respectively (p < 0.01). Patients after MEP had significant decrease in postoperative haemoglobin and sodium levels. All the groups showed statistically significant improvement in the aforementioned parameters following treatment.
Both laser enucleation techniques proved to be efficacious in the management of BPH. Monopolar enucleation of the prostate seems to be a highly promising addition to the list of enucleation techniques. It is an effective and acceptable procedure, despite having a higher complication rate.
Dmitry Enikeev– Deputy Director for Science, Institute for Urology and Reproductive health, Sechenov University, Moscow, Moskva, Russia
Leonid Rapoport– Deputy Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
Mark Taratkin– Researcher, Institute for Urology, Sechenov University, Moscow, Moskva, Russia
Deputy Director for Science
Institute for Urology and Reproductive health, Sechenov University
Moscow, Moskva, Russia
Experienced in TURP (>300 surgeries).
Experienced in upper urinary tract endosurgery (PCNL >200, RIRS >200).
2008-Present: Multiple upper and lower urinary tract surgeries;
2011-Present: HoLEP (400 surgeries);
2011-Present: En-bloc enucleation of bladder tumor (50 surgeries);
2016-Present: ThuLEP (>400 surgeries);
2016-Present: Thulium en-bloc enucleation of bladder tumor (>80 surgeries);
2016-Present: Brachytherapy (>40 surgeries); prostate cryoablation (70 surgeries), renal cancer cryoablation (30 surgeries);
Apr 2017-Present: Irreversible electroporation (10 surgeries);
Apr 2017-Present: MR-fusion prostate biopsy (80 procedures).
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia