Abstract
BackgroundOver the past years laser technology has played a predominant role in prostate surgery, for the treatment of benign prostate hypertrophy (BPH). Various laser devices have been introduced in clinical practice, showing good results in terms of complications and urodynamic outcomes efficacy compared with TURP and Open Prostatectomy.In this study we describe the efficacy and the safety profile of a novel laser technique, ThuLEP (Thulium Laser Enucleation of Prostate) that permits a complete anatomical endoscopic enucleation of prostatic adenoma independently to prostate size.Methods148 patients with a mean age of 68.2 years were enrolled between September 2009 and March 2012 (36 months), and treated for BPH with ThuLEP. Every patient was evaluated at base line according to: Digital Rectal Examination (DRE), prostate volume, Post-Voided volume (PVR), International Prostate Symptoms Score (I-PSS), International Index of Erectile Function-5 (IIEF-5), Quality of Life (QoL), PSA values, urine analysis and urine culture, uroflowmetry. The same evaluation was conducted after a 12 month follow-up. ThuLEP was performed by 2 expert surgeons.ResultsOur data showed a better post-operative outcome in terms of catheter removal, blood loss, TURP syndrome, clot retention and residual tissue compared to large series of TURP and OP. Only 1.3% of patients had bladder wall injury during morcellation. I-PSS, Qmax, Prostate Volume, QoL and PVR showed a highly significant improvement at 12 month follow-up in comparison to preoperative assessment.ConclusionThuLEP represent an innovative option in patients with BPH. It is a size independent surgical endoscopic technique and it can be considered the real alternative, at this time, to TURP and even more to Open Prostatectomy for large prostate, with a complete removal of adenoma and with a low complication rate.
Highlights
Over the past years laser technology has played a predominant role in prostate surgery, for the treatment of benign prostate hypertrophy (BPH)
Over the past decade laser endoscopic surgery has played a prominent role as an alternative to TURP and open prostatectomy (OP) for the treatment of benign prostatic enlargement (BPE) and obstruction (BPO) [1,2]
Various laser devices have been introduced in clinical practice during these years, and four groups of laser systems are currently used: KTP and LBO; Diode lasers; Holmium yttriumaluminum-garnet laser (Ho:YAG) and Thulium YAG (Tm-YAG) the others have been superseded [3,4]
Summary
Over the past years laser technology has played a predominant role in prostate surgery, for the treatment of benign prostate hypertrophy (BPH). Various laser devices have been introduced in clinical practice during these years, and four groups of laser systems are currently used: KTP (kalium titanyl phosphate, KTP:Nd:YAG [SHG]) and LBO (lithium borat, LBO:Nd: YAG [SHG]); Diode lasers (various); Holmium yttriumaluminum-garnet laser (Ho:YAG) and Thulium YAG (Tm-YAG) the others have been superseded [3,4] All of these transurethral laser operations need a physiologic sodium solution 0.9% for irrigation, and this eliminates the risk of hypotonic hypervolaemic TURP syndrome, that has been reported in large TURP series [5]. Tm-TAG is suitable for many transurethral prostate surgical techniques such prostate vaporization (ThuVAP), bladder neck incision [8], Vaporesection (ThuVARP) [9,10] It is indicated for Vapoenucleation of the prostate [6] that permits a complete removal of the prostatic adenoma using a blunt mechanical enucleation of the tissue. For some aspects it is like the “index finger” in open surgery for large prostate but with the advantages of laser energy to reduce bleeding and achieve safe hemostasis using the Thulium laser
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