Thulium laser enucleation of prostate: Novel therapy for benign prostatic hyperplasia

Abstract

Background: Transurethral resection of the prostate (TURP) has been the undisputed gold standard treatment for benign prostatic enlargement (BPE). However, morbidity after TURP remains significant with increased risk of bleeding and TUR syndrome. In recent years, the role of laser technology in endoscopic prostatic surgery has gradually increased. In our study, we evaluate the efficacy and safety of a novel technique of Thulium laser enucleation of prostate (THULEP) in the treatment of BPE.Materials and Methods: Five hundred and thirty-six patients with symptomatic benign prostatic hyperplasia (BPH) were treated with THULEP. The inclusion criteria were acute retention of urine with the failure of trial without catheter, dissatisfaction with medical treatment, maximum urinary flow rate (Qmax) <15 ml/s, and International Prostate Symptoms Score (IPSS) >15. Patients were evaluated by Digital rectal examination (DRE), uroflowmetry, IPSS, prostate-specific antigen (PSA), blood and urine routine tests, abdominal ultrasonography, and trans-rectal ultrasonography (TRUS).Results: The efficacy of THULEP was assessed by comparing preoperative variables with postoperative data. IPSS score got reduced from 24 to 3.5, quality of life score improved to 0–1 from 4–5. Qmax improved from mean 7 to 20 ml/s, Postvoid residue reduced from a mean of 110 to 12 ml. Hospital stay was < 36 h in the majority of patients. The average operative time was 45 min. No postoperative blood transfusion was required.Conclusion: THULEP is a safe procedure and has a lesser number of complications. THULEP can replace monopolar TURP as a gold standard for the treatment of BPH.