Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology

MP11-5 - Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate: a prospective randomized trial with 2-year follow-up

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

Introduction & Objective : To compare thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO) with a 24-month follow-up.


Methods : Ninety-four patients with symptomatic BPO were randomized to either ThuVEP (n=48) or HoLEP (n=46). All patients were assessed preoperatively and followed at 1, 6, 12, and 24 months postoperatively. International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), and PSA were obtained at each follow-up. Perioperative data and postoperative outcome were compared. The perioperative complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%).


Results : There were no significant differences between the surgical groups pre-operatively. Median age at surgery was 73 (67-76) yrs. and median prostate volume was 80 (46.75-100) gm. Fourty-three (45.7%) patients presented in urinary retention with an indwelling catheter. The operative time was 60 (41-79) minutes without differences between the groups. There were no differences between the groups regarding catheter time (2 (2-2) days) and postoperative stay (2 (2-3) days). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without differences between the groups. At 12-month follow-up, Qmax (10.7 vs. 23.3 ml/s), PVR (100 vs. 11.1 ml), IPSS (20 vs. 5), and QoL (4 vs. 1) differed significantly from baseline (p<0.001) without differences between the groups. A significant decrease of median PSA was found at 24-month (4.14 vs. 0.46 µg/l) follow-up (p<0.001) corresponding to a median PSA-decrease of 81.82 (67.53-94.11)% without differences between the groups. At 24-month follow-up, Qmax (10.7 vs. 22.8 ml/s), PVR (100 vs. 22 ml), IPSS (20 vs. 5), and QoL (4 vs. 1) had still improved significantly compared to baseline (p<0.001). However, median PVR was significantly lower after HoLEP (12.5 ml) compared to ThuVEP (29.9 ml) (p≤0.03) at 24-month follow-up. The reoperation rate was zero at 24-month follow-up. During the 24-month follow-up period, two episodes (2.1%) of acute urinary retention occurred and 7 (7.4%) patients developed urinary tract infections without differences between the groups.


Conclusions : ThuVEP and HoLEP are highly effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory micturition improvement with low morbidity and durable prostate volume reduction at 24-month follow-up.

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.

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.

Arcangelo Venneri Becci

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

Andreas J. Gross

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