Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology
Introduction & Objective :
To compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral thulium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia (BPH) with huge prostate volume (prostate >150 ml).
This retrospective study included 40 BPH patients treated by TURP (n = 20) or thulium laser enucleation (n = 20) from March 2015 to March 2018. We obtained the relevant data from the patients before, during and at 3, 6 months after surgery, and compared the two different surgical technique in operation time, perioperative levels of hemoglobin and sodium ion, post-operative urethral catheterization time and bladder irrigation time, pre- and post-operative serum PSA levels, International Prostate Symptoms Score (IPSS), post-void residual urine (PVR) volume and maximum urinary flow rate (Qmax), and incidence of post-operative complications
Thulium laser enucleation group showed a significant superiority over TURP in the perioperative levels of hemoglobin (［2.13 ± 1.08］ g/L vs ［5.77 ± 2.07］ g/L,(p<0.05) and Na+ (［3.58 ± 1.27］mmol/L vs ［9.67 ± 2.67］ mmol/L, p <0.01), Increased Qmax in 3 months(［11.54 ± 2.1］ g/L vs ［6.04± 2.07］ g/L, p <0.05), bladder irrigation time (［12.06 ± 4.8］h vs ［22.89 ± 7.25］ h, p <0.01), and urethral catheterization time (［47.61 ± 13.55］ h vs ［68.01 ± 9.69］ h, p <0.01), but a more significant decline than the latter in the postoperative PSA level (［6.34 ± 2.79］ ng/ml vs ［3.09 ± 1.23］ ng/ml, p<0.05). No blood transfusion was given, and nor postoperative transurethral resection syndrome or urethral stricture observed in thulium laser enucleation group. However, the incidence rate of postoperative urgent incontinence was significantly higher in the laser group (75%, 15/20) than in the TURP group (35%, 7/20) (p <0.05).
Thulium laser enucleation with its obvious advantages of less blood loss, higher safety, faster recovery, and more definite short-term effectiveness in huge prostate volume.
Wei-Tang Kao– Physician, Shaung-Ho Hospital, New Taipei, New Taipei, Taiwan (Republic of China)