Presentation Authors: Giordano Salvatore, Cluj Napoca, Romania, Giorgio Bozzini*, Busto Arsizio VA, Italy, Ian Coman, Cluj Napoca, Romania, Umberto Besana, Sergio Antonio Turno Chisena, Carlo Buizza, Busto Arsizio VA, Italy
Introduction: Thulium Laser enucleation of Prostate (ThuLEP) is currently one of the alternative to open prostatectomy in patients with BHP over 80 cc. Anyway large prostate glands enucleation is believed to be more complicated (despite the learning curve) and time-consuming procedure. The aim of our study is to report intraoperative, early and long term postoperative outcomes in BPH patients larger than 150 cc.
Methods: Our prospective study included 385 patients aged 68.2 (55-85) years with chronic and acute urinary obstruction (IPSS>20, Qmax < 12) due to BPH large than 150 cc. 193 patients (Group A) underwent ThuLEP and 192 patients (Group B) underwent open prostatectomy. Patients with urethral strictures, bladder stones, acute inflammation of the genitourinary tract or a history of prior prostate surgery were excluded. Cyber TM 200 (Quanta System, Italy) was employed with subsequent Piranha morcellator (Richard Wolf, Germany) to remove prostatic lobes. All patients were evaluated preoperatively and postoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR).
Results: Mean BPH volume was 196.0 cc (150-350 cc) in the ThuLEP group and 189.0 cc (150-280 cc) in the open prostatectomy group. Mean surgery time was 115.5Â±44.7 min for ThuLEP and 98.5Â±26.2 min for open prostatectomy. Mean mass of removed tissue was 149.0 g (group Ð) and 172.7 g (group B). Catheterization time was 1.7 days for group A and 8.5 days in group B. Hospital stay was 2.3 days in group A and 11.9 days in group B. Hemoglobin decrease was with a median value of 1.05 in group A vs 5.43 g/dL in group B. 27 group B patients (14.06%) required blood transfusion due to postoperative bleeding, this happened only in 3 patients in group A.. During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS and PVR.
Conclusions: Despite similar results after three months from the procedure simple transvescical prostatectomy is characterized by longer postoperative hospitalization and catheterization time and more blood loss than ThuLEP. Even without statistical evidence ThuLEP is a little bit longer surgical procedure but it proved to be a safer treatment option for BPH over 150 cc.