Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology
Introduction & Objective :
Monopolar transurethral resection of the prostate (TURP) is the treatment of choice and most frequently performed surgery for prostate glands >80 cc. Thulium fiber laser enucleation of the prostate (ThuFLEP) is a less invasive treatment option for BPH due to minimal penetration of laser energy (0.2 mm) and tissue coagulation. The aim of our study was to compare TURP and ThuFLEP and show high efficacy of ThuFLEP in management of BPH in patients with small prostate glands (>60 cc).
Our retrospective study included 197 patients with prostate volume less than 60 cc aged 66.1 (54-82) years with infravesical obstruction (IPSS>20, QmaxRussia), a 120 W thulium fiber laser, and a 600 µm fiber. Tissue removal from the bladder was performed with the help of a Piranha morcellator (Richard Wolf, Germany). Prior to and following surgery, serum sodium and hemoglobin levels were assessed. Preoperatively and six months after surgery we evaluated IPSS, QoL, Qmax and post-void residual volume. 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.
Mean surgery time in the ThuFLEP group was higher (48.1±17.6 min) than in the TURP group (37.9±18.6 min) (p<0.05). Mean mass of removed tissue was 19.9 g (group А) and 18.7 g (group B). Catheterization time was 26.9 hours in group A and 45.2 hours in group B. Hospital stay was 2.7 days in group A and 6.5 days in group B. Stress urinary incontinence following catheter removal was observed in 6.8% of cases in group A and in 10.3% of cases in group B. Hemoglobin level decreased by an average of 1.01 g/dL in group A and 3.00 g/dL in group B. Similarly, serum sodium level decreased by an average of 0.9 mmol/L in group A and 3.1 mmol/L in group B. Postoperative bleeding was noted in 1.3% of patients in group A and 3.9% of patients in group B. Six months after surgery, we observed a statistically significant improvement in IPSS, QoL, Qmax and post-void residual volume in all the patients (p<0.05). There were no differences in the above mentioned parameters between the two groups<./p>
Despite taking longer to perform, ThuFLEP for BPH in patients with small prostate glands (>60 cc) allowed for decreasing postoperative complication rates and considerably improving voiding parameters. Mean catheterization time and hospital stay were significantly lower in the laser enucleation group. Thus, ThuFLEP, in spite of its higher difficulty, is preferable to TURP for the patient who can recover quicker and return to his or her normal life.
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