Comparing surgical techniques: ThuLEP and transurethral BPEP for prostate over 80 grams. Intraoperative and postoperative results. A prospective randomized trial

Abstract

ABSTRACT Background and purpose Though TURP remains the primary treatment for BPH, advancements in energy and technology have introduced innovative transurethral surgical options. In this study, we assessed and compared the effectiveness and safety of using thulium laser and bipolar for endoscopic enucleation of prostate exceeding 80 g. Patients and methods Between January 2022 and July 2023, this study enrolled patients with LUTS due to BPH and a prostate size of ≥80 g. Group A underwent the BPEP procedure using a 26 Fr continuous flow resectoscope with plasma kinetic system enucleation loops, while Group B underwent the ThuLEP procedure using a 120–200 W Revolix DUO® Thulium laser. Data collection included prostate size, PSA levels, enucleation and morcellation time, and postoperative IPSS and IIEF-5 scores at one, 3, 6, and 12 months. Results A total of 108 patients, divided into Group A (BPEP) and Group B (ThuLEP), completed a 12-month follow-up. The mean age for group A was 67.72 ± 7.02 compared to group B which was 62.33 ± 5.86. While Group A compared to group B had higher mean enucleation (75.22 ± 10.55 vs. 67 ± 12.18) and total operative times (117.22 ± 17.76 vs.90.5 ± 18.29) (p = 0.037 & <0.001 respectively), no significant differences were observed in resected tissue weight, blood transfusion, and morcellation time. The ThuLEP group exhibited a shorter mean catheter period 2.94 ± 0.94 d compared to BPEP 3.33 ± 0.91 d and shorter mean hospital stay period of 1.94 ± 0.54 compared to2.11 ± 0.32, though not statistically significant. Postoperative outcomes, including IPSS, Qmax, PVRU, and IIEF-5 at 1, 3, 6, and 12 months, showed no differences between the groups. Conclusion ThuLEP shows better perioperative parameters in comparison to BPEP. Nevertheless, there are no notable differences in functional results and complications between the two techniques.