Thulium Laser Enucleation Of Prostate Research Articles

Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis.

To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.

Thirty versus 60-Watt thulium laser enucleation of prostate: Toward the development of low-power anatomical enucleation of the prostate.

We aimed to study whether using 30 W versus 60 W thulium enucleation of the prostate (ThuLEP) would affect postoperative outcomes in patients with benign prostatic hyperplasia (BPH). We prospectively identified male patients with moderate or severe lower urinary tract symptoms due to BPH. We randomized patients into 30 W (Group 1) or 60 W (Group 2) thulium yag laser with a 550 μm laser fiber and a 26 Fr continuous flow resectoscope. We collected data related to prostate size, enucleation time, morcellation time, laser time, perioperative complications, and 1-year functional outcomes. A total of 120 patients were included, with a mean age of 67 years and a mean prostate size of 105 g. The preoperative characteristics were similar across both groups. The mean operative time was shorter in the 60 W group, 74 ± 27 vs. 91 ± 33 min in the 30 W group (P = 0.001), and the mean laser time was 55 ± 20 in 60 W versus 71 ± 25 in 30 W (P = 0.0001). The mean hospital stay was 1 day in both groups and at 1-year follow-up; there was a similar improvement in mean Qmax and International Prostate Symptom Score symptom scores. Both 30 and 60 W ThuLEP provided a safe and comparable outcome with a relatively shorter operative time for the 60 W groups. Perhaps using a 30-W setting would be beneficial in the early learning curve or cases with more bleeding capsular perforators; besides, the financial benefit of manufacturing low-cost low-power devices that may help in the widespread of AEEP.

Comparison of efficacy and safety of transurethral thulium laser vapoenucleation of prostate and transurethral thulium laser enucleation of prostate in the treatment of benign prostatic hyperplasia

Objective: To compare early outcomes between transurethral thulium laser vapoenucleation of prostate and transurethral thulium laser enucleation of prostate for the treatment of benign prostatic hyperplasia (BPH). Methods: Retrospective analysis was conducted on the clinical data of 1 638 BPH patients admitted to the Department of Urology of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021. There were 916 patients underwent transurethral thulium laser vapoenucleation of prostate (ThuVEP group) and 722 patients underwent transurethral thulium laser enucleation of prostate (ThuLEP group). The operation time, eliminated tissue weight, surgical complications, duration of post-operative catheter implantation were compared between the two groups. The improvement of International Prostate Symptom Score (IPSS), Quality of Life Index (QoL), maximum uroflow rate (Qmax) and post-void residual urine volume (PVR) at 1 month after operation was compared between the two groups. Results: There were no significant differences in age, preoperative and 1-month postoperative prostate volume, IPSS score, QoL score, Qmax, and PVR between the ThuVEP and ThuLEP group (all P>0.05). There were no significant differences in perioperative indicators such as operation time, cutting or enucleation time, tissue crushing time, tissue weight, hemoglobin change, catheter indwelling time, and postoperative hospital stay between ThuVEP group and ThuLEP group (all P>0.05). The incidence of minor gross hematuria after extubation in the ThuVEP group was 7.8% (56/916), which was lower than 9.4% (65/722) in the ThuLEP group (P=0.026); the incidence of temporary incontinence at 1 month after surgery was 5.2% (38/916) in ThuVEP group, lower than 11.9% (86/722) in ThuLEP group (P<0.001). A total of 3 patients (0.4%) in ThuLEP group required operative intervention for severe post-operation bleeding, but none of ThuVEP group suffered from this kind of surgical complications. Conclusions: ThuVEP has similar efficacy with ThuLEP for the treatment of BPH. ThuVEP can significantly reduce the incidence of post-operation temporary urine incontinence, and has much superiority in stanching bleeding.

Surgical treatment of benign prostatic hyperplasia: Thulium enucleation versus single-port transvesical robotic simple prostatectomy.

The objective of this work is to compare our outcomes using thulium laser enucleation of prostate (ThuLEP) to the single-port robot-assisted simple prostatectomy (SP RASP) in the surgical management of benign prostatic hyperplasia (BPH). A retrospective cohort study was conducted from January 2017 through December 2021 of men who underwent SP RASP and ThuLEP performed by a single surgeon with an enucleation experience of >300 cases and extensive robotic experience. The primary outcome was changed in International Prostate Symptom Score (IPSS) postoperatively. Secondary outcomes were operative time, length of stay (LOS), change in post-void residuals (PVR), de novo stress- or urge-urinary incontinence (SUI, UUI), and rate of complications. One hundred two patients underwent surgery during the study period: 33 RASP and 69 ThuLEP. There was no difference in preoperative characteristics, including age and body mass index, between both groups. Changes in IPSS scores postoperatively were not significant between SP RASP versus ThuLEP (-17 vs. -14, p = 0.2956). SP RASP had a longer operative time (180 vs. 90 min, p < 0.0001). There was no difference in LOS (0 vs. 0days, p = 0.2904). There was no difference in change in PVR (-96 vs. -91 mL, p = 0.8504). SP RASP patients had significantly less postoperative SUI than ThuLEP (0 vs. 13 patients, p = 0.0083), while there was no difference in UUI between both groups (4 vs. 2 patients, p = 0.0843). There was no difference in 30-day complication rate (21.2% vs. 21.7%, p = 0.9517), although there were three ThuLEP patients with Clavien-Dindo Class III or higher complication. There was no difference in change in IPSS scores between the two groups. ThuLEP is associated with shorter postoperative catheter days and decreased operative times. Hospital LOS was equivalent. SP RASP demonstrates significantly improved continence rates. Though SP RASP is within the initial learning curve at our institution, early results demonstrate the role for this modality alongside ThuLEP in the treatment of large gland BPH.

Thulium laser enucleation of prostate (ThuLEP): efficacy and safety evaluation in patients with a prostate volume more than 80 cm3

BACKGROUND: Benign prostatic hyperplasia is a common condition in men over 60 years of age. The gold standard for the treatment of benign prostatic hyperplasia up to 80 cm3 is transurethral resection of the prostate. At the same time, with a prostate volume of more than 80 cm3, the choice of the optimal method of surgical treatment of benign prostatic hyperplasia is a matter of debate.&#x0D; AIM: Evaluation of the efficacy and safety of thulium laser enucleation of the prostate (ThuLEP) in patients with benign prostatic hyperplasia with a prostate volume of more than 80 cm3.&#x0D; MATERIALS AND METHODS: The study involved 75 patients with benign prostatic hyperplasia aged 64 to 83 years (mean age 70.4 years) with a prostate volume of 80 to 215 cm3 (mean 123.9 cm3). All patients underwent ThuLEP using a thulium fiber laser FiberLase U1 with a power of 120 W. Control examinations were performed 3 and 6 months after the surgery.&#x0D; RESULTS: The duration of surgery averaged 84.7 minutes and ranged from 57 to 135 minutes. The duration of the urethral catheter after surgery averaged 2.8 days. The frequency of intra- and postoperative complications was low, none of the patients required blood transfusion, as well as repeated surgery to coagulate the vessels of the prostate bed. In 3 (4%) patients, superficial damage to the bladder wall occurred during marcellation, which required coagulation of the injury site. All recorded complications belonged to groups I and II according to the Clavien Dindo scale. Examinations carried out after 3 and 6 months showed a significant decrease in the severity of voiding disorders, an increase in the quality of life and an improvement in the outflow of urine from the bladder compared with the baseline.&#x0D; CONCLUSIONS: The results of the study showed high clinical efficacy and safety of the use of thulium laser enucleation of benign prostatic hyperplasia in patients with prostates more than 80 cm3.

Thulium laser enucleation of prostate versus laparoscopic trans-vesical simple prostatectomy in the treatment of large benign prostatic hyperplasia: head-to-head comparison.

ABSTRACTObjectives:To compare thulium laser enucleation of prostate (ThuLEP) versus laparoscopic trans-vesical simple prostatectomy (LSP) in the treatment of benign prostatic hyperplasia (BPH).Materials and Methods:Data of patients who underwent surgery for “large” BPH (>80mL) at three Institutions were collected and analyzed. Two institutions performed ThuLEP only; the third institution performed LSP only. Preoperative (indwelling catheter status, prostate volume (PVol), hemoglobin (Hb), Qmax, post-voiding residual volume (PVR), IPSS, QoL, IIEF-5) and perioperative data (operative time, enucleated adenoma, catheterization time, length of stay, Hb-drop, complications) were compared. Functional (Qmax, PVR, %ΔQmax) and patient-reported outcomes (IPSS, QoL, IIEF-5, %ΔIPSS, %ΔQoL) were compared at last follow-up.Results:80 and 115 patients underwent LSP and ThuLEP, respectively. At baseline, median PVol was 130 versus 120mL, p <0.001; Qmax 9.6 vs. 7.1mL/s, p=0.005; IPSS 21 versus 25, p <0.001. Groups were comparable in terms of intraoperative complications (1 during LSP vs. 3 during ThuLEP) and transfusions (1 per group). Differences in terms of operative time (156 vs. 92 minutes, p <0.001), Hb-drop (-2.5 vs. −0.9g/dL, p <0.001), catheterization time (5 vs. 2 days, p <0.001) and postoperative complications (13.8% vs. 0, p <0.001) favored ThuLEP. At median follow-up of 40 months after LSP versus 30 after ThuLEP (p <0.001), Qmax improved by 226% vs. 205% (p=0.5), IPSS decreased by 88% versus 85% (p=0.9), QoL decreased by 80% with IIEF-5 remaining almost unmodified for both the approaches.Conclusions:Our analysis showed that LSP and ThuLEP are comparable in relieving from BPO and improving the patient-reported outcomes. Invasiveness of LSP is more significant.

The efficacy of a suppository based on Phenolmicin P3 and Bosexil (Mictalase\xae) in control of irritative symptoms in patients undergoing thulium laser enucleation of prostate: a single-center, randomized, controlled, open label, phase III study

BackgroundSeveral studies described post-operative irritative symptoms after laser enucleation of prostate, sometimes associated with urge incontinence, probably linked to laser-induced prostatic capsule irritation, and potential for lower urinary tract infections We aimed to evaluate the efficacy of a suppository based on Phenolmicin P3 and Bosexil (Mictalase®) in control of irritative symptoms in patients undergoing thulium laser enucleation of prostate (ThuLEP).MethodsIn this single-center, prospective, randomized, open label, phase-III study, patients with indication to ThuLEP were enrolled (Dec2019–Feb2021—Institutional ethics committee STS CE Lazio approval no.1/N-726—ClinicalTrials.gov NCT05130918). The report conformed to CONSORT 2010 guidelines. Eligible patients were 1:1 randomized. Randomization defined Group A: patients who were administered Mictalase® suppositories twice a day for 5 days, then once a day for other 10 days; Group B: patients who did not receive Mictalase® (“controls”). Study endpoints were evaluated at 15 and 30 days postoperation. Primary endpoint included evaluation of effects of the suppository on irritative symptoms by administering IPSS + QoL questionnaire. Secondary endpoint included evaluation of effects on urinary tract infections by performance of urinalysis with urine culture.Results111 patients were randomized: 56 in Group A received Mictalase®. Baseline and perioperative data were comparable. At 15-days, no significant differences were found in terms of IPSS + QoL scores and urinalysis parameters. A significant difference in the rate of positive urine cultures favored Group A (p = 0.04). At 30-days follow-up, significant differences were found in median IPSS score (6 [IQR 3–11] versus 10 [5–13], Group A vs B, respectively, p = 0.02). Urinalysis parameters and rate of positive urine cultures were not significantly different.ConclusionsThe present randomized trial investigated the efficacy of Mictalase® in control of irritative symptoms and prevention of lower urinary tract infections in patients undergoing ThuLEP. IPSS improvement 30-days postoperation was more pronounced in patients who received Mictalase®. Lower rate of positive urine culture favored Mictalase® group 15-days postoperatively.Trial registrationThe clinical trial has been registered on ClinicalTrials.gov on November 23rd, 2021—Registration number NCT05130918.

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

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.

Combined top-down approach with low-power thulium laser enucleation of prostate: evaluation of one-year functional outcomes.

To evaluate the safety and efficacy of combined top and down low power thulium laser enucleation of the prostate (ThuLEP). Between May 2017 and May 2019, after institutional board review approval, successfully consented patients underwent combined top and down low power ThuLEP. We used a 30 -W Thulium laser with a 550μm laser fiber and a 26 Fr continuous flow resectoscope. We collected data related to prostate size, enucleation time, morcellation time, perioperative complications, and early outcomes. Sixty patients underwent combined Top and down low power ThuLEP with mean age 67 ± 8. Acute urine retention was the main indication for surgery in 22% of patients, while the remaining had mean IPPS score 26 ± 3. The mean prostate volume was 102 ± 25ml and the mean Qmax was 6 ± 2ml/sec. Mean operative time was 103 ± 25min, while; mean enucleation time was 80 ± 12min, and mean morcellation time was 17 ± 6min. The mean enucleated prostate volume was 73 ± 16g and the mean hemoglobin drop was 1 ± 0.2mg/dl. There was no need for blood transfusion and the mean hospital stay was 18 ± 4h and catheters were removed on discharge. The 1st visit was at one month, and we observed significant mean Qmax improvement18 ± 5ml/s. Our results showed no significant change of IIEF-5 score at 12-month follow-up compared to baseline. Low-power Thulium enucleation with a combined top and down technique provided a safe and efficacious outcome, that may reduce strenuous wrist flexion and eliminate the need for high-power Thulium laser device.

Is Thulium laser enucleation of prostate an alternative to Holmium and TURP surgeries - A systematic review?

To assess efficacy and safety of Thulium laser enucleation of prostate (ThuLEP) for benign prostatic hyperplasia. It is a systemic review based on a comprehensive search of PubMed, Cochrane, and Google scholar databases from inception to 31 March 2020. All studies in English evaluating ThuLEP as well as those comparing it with Transurethral resection of prostate (TURP) and Holmium Laser enucleation of prostate (HoLEP) were enrolled. The primary outcome was to evaluate operative, postoperative, and functional outcomes (IPSS, QoL, Qmax, PVR) in patients undergoing ThuLEP. Secondary outcome was to compare operative, postoperative, and functional outcomes with TURP and HoLEP in comparative studies. Fourteen studies with a total of 2,562 patients were included in this review. 2,034 underwent ThuLEP, 349 underwent TURP, and remaining 139 had HoLEP. We found that ThuLEP is safe as well as efficacious in all age groups as well as across all prostate sizes and with all four functional outcomes (IPSS, QoL, Qmax, PVR) revealing marked improvement at 3, 6, 12, and 24 months. Compared to TURP and HoLEP, Thulep is non-inferior in terms of operative and functional outcomes and, in fact, is associated with lesser catheterization duration as well as shorter hospital stay. Further, Thulium fiber laser (TFL) has advantages of being light weight, having high frequency, less fiber degradation, and less energy consumption, making it cost effective for operational and maintenance purpose. ThuLEP is a safe, efficacious, and cost-effective procedure for BPE.

Benign Prostatic Hyperplasia: Clinical Manifestations, Imaging, and Patient Selection for Prostate Artery Embolization

Prostate artery embolization (PAE) has been shown to be safe and effective at treating lower urinary tract symptoms (LUTS), urinary retention, and hematuria caused by benign prostatic hyperplasia (BPH). To distinguish from other causes of these symptoms, a multidisciplinary evaluation by a urologist and interventional radiologist should include a complete history to screen for any nonprostate causes of LUTS. The International Prostate Symptom Score is a useful objective measure to quantify the patient's urinary complaints. A physical exam should be performed to evaluate a patient's candidacy for angiography, and baseline laboratory evaluation should ensure that the patient's coagulation and kidney function are adequate. In certain situations, patients may benefit from cystoscopy and urodynamic evaluation to ensure their symptoms are related to BPH. A review of the patient's imagining can be the most important component of the evaluation of a patient prior to PAE, because a patient's gland size is often a primary driver of what procedural options available are to him. Men with small glands (≤30 mL) can be treated with several of the available minimally invasive transurethral procedures, but larger glands (≥80-120 mL) may be limited to holmium laser enucleation of prostate, thulium laser enucleation of prostate, surgical prostatectomy, or PAE, depending on institutional practice patterns. Secondary considerations include medical comorbidities, the risks for sexual side effects, the risk for bleeding, and the possible adverse events associated with the procedure, which are all low for PAE. Most patients suffering from symptomatic BPH resulting in LUTS, retention, or hematuria will benefit from PAE.

Postoperative outcomes and safety of bipolar transurethral enucleation and resection of the prostate

Postoperative outcomes and safety of bipolar transurethral enucleation and resection of the prostate

Are Histological Findings of Thulium Laser Vapo-Enucleation Versus Transurethral Resection of the Prostate Comparable?

We investigated if an adequate histological diagnosis can be made from tissue after Thulium laser vapo-enucleation of the prostate (ThuVEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with symptomatic benign prostatic hyperplasia. We analyzed 350 ThuLEP and 100 matched TURP tissue specimens from patients who underwent one of the two procedures between January 2009 and June 2014. Thulium Laser Enucleation of Prostate (ThuVEP) was combined with mechanical morcellation of the resected lobe. Each histological specimen was reviewed by two pathologists. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups (2.5 % in the ThuVEP group versus 3 % in the TURP group). Tissue thermal artifacts induced by the Thulium laser are mostly due to coagulation as that of the conventional monopolar diathermy in TURP. Tissue quality was maintained in the ThuVEP histological specimens. Tissue maintain histological characteristics and proprieties without modification for successive immunoistochemical analysis. The pathologist ability to detect incidental prostate cancer and PIN was maintained even if there is a quoted of vaporized tissue.

2181 ARE HISTOLOGICAL FINDINGS OF THULIUM LASER ENUCLEATION VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE COMPARABLE?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (III)1 Apr 20132181 ARE HISTOLOGICAL FINDINGS OF THULIUM LASER ENUCLEATION VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE COMPARABLE? Luca Carmignani, Stefano Picozzi, Stefano Casellato, Giorgio Bozzini, Carlo Marenghi, and Serena Maruccia Luca CarmignaniLuca Carmignani San Donato Milanese, Italy More articles by this author , Stefano PicozziStefano Picozzi San Donato Milanese, Italy More articles by this author , Stefano CasellatoStefano Casellato San Donato Milanese, Italy More articles by this author , Giorgio BozziniGiorgio Bozzini San Donato Milanese, Italy More articles by this author , Carlo MarenghiCarlo Marenghi San Donato Milanese, Italy More articles by this author , and Serena MarucciaSerena Maruccia San Donato Milanese, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2090AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We investigated if an adequate histological diagnosis can be made from tissue after Thulium laser enucleation of the prostate (ThuLEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with symptomatic benign prostatic hyperplasia. METHODS We analyzed 100 ThuLEP and 100 matched TURP tissue specimens from patients who underwent 1 of the 2 procedures between January 2009 and October 2012. Thulium Laser Enucleation of Prostate was combined with mechanical morcellation of the resected lobe. Each histological specimen was reviewed by two pathologists. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. RESULTS Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups (4% in the ThuLEP group versus 5% in the TURP group). Tissue thermal artifacts induced by the Thulium laser are mostly due to coagulation as that of the conventional monopolar diathermy in TURP. CONCLUSIONS Tissue quality was maintained in the ThuLEP histological specimens. Tissue maintain histological characteristics and proprieties without modification for successive immunoistochemical analysis. The pathologist ability to detect incidental prostate cancer and PIN was maintained even if there is a quoted of vaporized tissue. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e894 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Carmignani San Donato Milanese, Italy More articles by this author Stefano Picozzi San Donato Milanese, Italy More articles by this author Stefano Casellato San Donato Milanese, Italy More articles by this author Giorgio Bozzini San Donato Milanese, Italy More articles by this author Carlo Marenghi San Donato Milanese, Italy More articles by this author Serena Maruccia San Donato Milanese, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...