Category: BPH/LUTS: Outcomes & Complications

MP11-9 - Endoscopic enucleation of the prostate (EEP): a retrospective matched-paired comparison of three techniques

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective : Since the introduction of holmium laser enucleation of the prostate (HoLEP), other techniques of endoscopic enucleation of the prostate (EEP) have been established as alternatives for transurethral resection of the prostate and open prostatectomy. Aim of this study was to compare the perioperative data and the functional outcomes of three different techniques of EEP from a single center, including thulium laser vapoenucleation of the prostate (ThuVEP), HoLEP, and bipolar enucleation of the prostate (BipolEP).


Methods : 159 patients from our prospective collected database, treated between January 2016 and December 2017 at our institution, who had undergone EEP due to benign prostatic obstruction (BPO) were included in this study. A retrospective matched-paired comparison of patients treated with ThuVEP (n=53), HoLEP (n=53), or BipolEP (n=53) according to prostate size was carried out. All patients were pre-operatively assessed with transrectal ultrasound of the prostate, International Prostate Symptom Score (IPSS), quality of life (QoL) maximum urinary flow rate (Qmax), and post-void residual volume (PVR). Intra-, peri-, and postoperative parameters were evaluated and the patients were reassessed at 6-month follow-up with the same examinations. Patient data were expressed as median (interquartile range). A p-value < 0.05 was considered as statistically significant.


Results :

The median age was 71 (65-76) years and the median prostate volume was 70 (46-90) ml and did not differ significantly between the groups. The median operative time was 65 (40-81) minutes without significant differences between the groups. The percentage of resected tissue (resected weight/preoperative prostate volume) tended to be lower in ThuVEP (66.67 (50.51-85.99) %) compared to HoLEP (73.85 (53.14-85.34) %) and BipolEP (73.31 (57.14-86) %) but passed the level of significance (p=0.867). There were no significant differences between the groups with regards to catheterization time (2 (2-2) days) and postoperative stay (2 (2-2) days). Clavien 1 (8.2%), 2 (3.1%), 3a (0.6%), and 3b (1.3%) complications occurred without significant differences between the groups. The transfusion rate was 1.3% (n=2) and did not differ significantly between the groups. At 6-month follow-up, median Qmax (11.1 vs. 25.8 ml/s), PVR (150 vs. 12 ml), IPSS (22 vs. 5), and QoL (5 vs. 1) had improved significantly (p


Conclusions : This study demonstrates the perioperative safety and efficacy of EEP procedures for the treatment of BPO. All three procedures give satisfactory micturition improvement at 6-month follow-up with low perioperative morbidity.

Benedikt Becker

Resident
Asklepios Klinik Barmbek, Department of Urology
Hamburg, Hamburg, Germany

Dr. Becker is a resident of urology in the urological department of the Asklepios Hospital Barmbek in Hamburg, Germany. He studied in Giessen and Lübeck (both Germany). His main scientific interest is the broad spectrum of endourology, especially laser treatment of benign prostatic obstruction. He is an active member of the German Society of Urology (DGU), the German Society of Residents in Urology (GeSRU), and the Endourological Society (WCE). At this time, he is participating in the Two Year fellowship program in Endourology/Stone Surgery.

Andreas J. Gross

Head of Department
Asklepios Klinik Barmbek, Abteilung für Urologie
Hamburg, Hamburg, Germany

Christopher Netsch

Consultant
Asklepios Klinik Barmbek, Abteilung für Urologie
Hamburg, Hamburg, Germany

Dr. med. Dr. habil. Christopher Netsch, MD, FEBU is an Assistant Professor of Urology at the Semmelweis University of Budapest/Hungary. He received his medical degree from the University of Mainz/Germany. His training in urology was conducted at the Inselspital Bern/Switzerland, Städtisches Klinikum Karlsruhe/Germany and at the Asklepios Klinik Barmbek/Germany. After his board certification in 2011 (Hamburg/Germany), Dr. Netsch became a consultant urologist at the Asklepios Klinik Barmbek/Germany. Dr. Netsch completed his Endourology Fellowship at the Asklepios Klinik Barmbek in 2012. He was also qualified as a Fellow of the European Board of Urology (FEBU) in 2015.
Dr. Netsch`s research focuses on urolithiasis and minimally-invasive therapies for BPH. He has authored or co-authored over 70 peer-reviewed journal articles and numerous book chapters. He was awarded with the Mauermayer award of the German Society of Urology (DGU) in 2013 and the Hans Marberger award of the European Association of Urology (EAU) in 2014. He is currently an editorial consultant for the World Journal of Urology.
Dr. Netsch is a member of the DGU Urolithiasis Guidelines committee. He is also an active member of numerous national and international societies such as the DGU, EAU, and the Endourological Society. He is also a member of the DGU working group in Endourology and the EAU section of Uro-Technology (ESUT): Lower Tract Section.