Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology
Introduction & Objective :
The objective of the study was to evaluate functional outcomes in patients with indwelling catheters for refractory urinary retention (RUR) underwent to thulium laser prostate vapoenucleation (ThuVep).
From January 2012 to August 2015 we prospectively enrolled patients undergoing ThuVep for benign prostate hyperplasia with indwelling catheters. Every episode of urinary retention was treated with urinary catheter positioning followed by at least two attempts of catheter removal. Incomplete bladder emptying was considered and defined as a post-void residual urine volume of 300 ml. Patients were investigated with flowmetry and the self-administered International Prostate Symptom Score (IPSS) questionnaire at 1, 3 and 12 month following ThuVep.
381 patients underwent ThuVep between January 2012 and August 2015; 99 of these had indwelling catheters, but only 93 (24%) were eligible according to the inclusion criteria. In 46 patients the bladder catheter was removed on the first post-operative day, in 31 patients on the second post-operative day, in 5 patients on the third, in 6 patients on the fourth, in 1 patient on the fifth and in 2 patients each on the sixth and seventh day. The average hospital stay was 2.3 (± 1.7) days. No patients undergoing ThuVep, at the 90-day follow-up, required further catheterization, on the other hand one year after surgery 6 patients had indwelling catheter and 1 patients started self-autocatheterization for incomplete bladder emptying. Flowmetry showed significant improvement in all parameters (Qmax pre-operatively = 7.1 ml/sec; 1 month post-operatively = 21.25 ml/sec, 3 months post-operatively = 16.81 ml/sec and 12 months= 19.5ml/sec . The mean IPSS score dropped from 21.33 pre-operatively to 4.84, 3.2 and 7 at 1, 3 and 12 months post-operatively (p < 0.05), respectively.
The main limitations of our study are the single-centre, non-randomised study design, the lack of a control group (i.e. patients without RUR), and the absence of pre-operative urodynamic investigations. However the prospective study design, the standardization of the ThuVep technique and the accuracy of data collected may counterbalance its main limits.
This prospective study shows that in patients with RUR, even in those with potentially impaired detrusor function, the ThuVep represents a safe and effective therapeutic option with satisfying and promising outcomes. Regarding patients with no benefit at one year after surgery a valid urodynamic assessment is necessary to understand factors associated with treatment failure particularly considering their previous recover of bladder emptying function.
Claudia Signorini– Resident, IRCCS Policlinico San Donato, Paderno Dugnano, Lombardia, Italy
Damiano Vizziello– Resudent, Policlinico San Donato, Milan, Lombardia, Italy
Gloria Motta– Milan, Lombardia, Italy
Maria Chiara Clementi– Milan, Lombardia, Italy
Oskar Blezien– Milan, Lombardia, Italy
Sebastiano Nazzani– Milan, Lombardia, Italy
Dario Ratti– Milan, Lombardia, Italy
Elisabetta Finkelberg– Milan, Lombardia, Italy
Pietro Acquati– Milan, Lombardia, Italy
Serena Maruccia– Milano, Lombardia, Italy
Luca Carmignani– Milan, Lombardia, Italy
IRCCS Policlinico San Donato
Paderno Dugnano, Lombardia, Italy