Introduction & Objective :
TURP is considered the standard treatment option for patients with benign prostatic hyperplasia (BPH) ≤ 80 cc. However, up to 14.7% of the patients require secondary TURP due to recurrent BPH. The aim of our work was to describe specific features of holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) in BPH relapse; further we aimed to illustrate that technical difficulties pose no threat to the widespread use of these techniques.
Our study included 768 patients with the International Prostate Symptom Score>20 or Qmax <10. Group I (489 patients) underwent HoLEP; group III (253 patients) underwent ThuLEP; group II (17 patients) and Group IV (9 patients) included cases of BPH relapse that were managed with HoLEP and ThuLEP, respectively. All statistical analyses were performed using SPSS Statistics 22.0 (SPSS Inc., Chicago, IL, USA). A p-value of 0.05 was chosen as a threshold for statistical significance.
There was no significant difference in preoperative parameters. Six months after surgery, postoperative parameters (IPSS, Qmax, quality of life, post-void residual volume) showed statistically significant improvement. HoLEP and ThuLEP efficacy assessment yielded the following results: no statistically significant difference (p>0.05) was found between the mean masses of resected tissue after primary and repeated surgery; mean duration of repeated and primary endoscopic enucleation of the prostate was not significantly different (p>0.05); no difference in hospitalization and catheterization times was noted between all groups (p>0.05). Transient stress urinary incontinence after urinary catheter removal was observed in 8.2% in the primary HoLEP group (40 patients), in 5.9% in the primary ThuLEP group (15 patients), and in 11.7% after secondary HoLEP (2 patients); incontinence wasn’t noted in the secondary ThuLEP group. At 6-months, de novo stress incontinence was observed in 0.8% patients after primary HoLEP (4 patients), and in 0.8% after primary ThuLEP (3 patient). At 6-months, no incontinence was found in groups III and IV (after secondary procedures) which was most likely due to small number of patients in these two groups<./p>
Our results indicate that technical difficulties associated with repeated surgery were easily overcome (poor visibility of the layers, multinodular adenoma, increased tissue density). Given these results, we can consider laser enucleation of the prostate a potentially safe and effective procedure, both in primary and repeated benign prostatic hyperplasia surgery.
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