Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: a systematic review and meta-analysis

Anatomic endoscopic enucleation of the prostate using a novel hybrid thulium:yttrium-aluminium-garnet laser generator: surgical technique and clinical outcomes

PURPOSE

We aim to report here the first clinical series of patients treated with AEEP using a novel hybrid thulium:yttrium-aluminium-garnet (Tm:YAG) laser generator (RevoLix HTL, LISA Laser Products, Germany), i.e. capable of emitting both in pulsated and continuous-wave.

METHODS

We included 39 consecutive patients who underwent hybrid Tm:YAG AEEP (hybrid ThuLEP) at a single center starting from July 2022 and were followed-up until 3 months after surgery. Complete baseline, intraoperative, and follow-up demographic and clinical data were collected. The International Prostatic Symptoms Score (IPSS) questionnaire was used to quantify urinary symptoms at baseline and during follow-up. Post-operative follow-up further included a PSA test, uroflowmetry with post-void residual volume (PVR) measurement. Clavien-Dindo classification was used to classify complications.

RESULTS

Median (IQR) age at surgery and prostate volume were 68 (IQR 63-74) years and 85 (60-105) cc. Both en-bloc or two-lobes technique enucleation were performed according to the intraoperative and endoscopic anatomy, with a median operative time of 85 (63-108) minutes. Bladder catheter was removed in all cases on postoperative day two. Intraoperative bleeding requiring conversion to bipolar enucleation was observed in two patients. After discharge, one patient developed arm phlebitis which was treated with anticoagulants leading to new onset haematuria requiring short term catheterisation (Clavien-Dindo grade II) and two more patients had a single episode of acute urinary retention (Clavien-Dindo grade I). Median pre- vs postoperative Qmax and IPSS were 8.0 (7.0-9.4) vs. 25.0 (22.5-32.5) ml/s and 22 (20-28) vs. 1 (0-2), whereas PVR decreased from 70 (50-115) to 0 (0-26) ml.

CONCLUSIONS

Hybrid ThuLEP is a feasible and effective surgical procedure for the management of benign prostatic obstruction.

Multimodal Approach Combining Thulium Laser Vaporization, Bipolar Transurethral Resection of the Prostate, and Bipolar Plasma Vaporization versus Bipolar Transurethral Resection of the Prostate: A Matched-Pair Analysis

Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (-0.3 versus -0.6, p < 0.001) and median sodium drop (-0.3 versus -0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique.

Comparative efficacy and safety of greenlight and thulium laser vaporization techniques for benign prostatic hyperplasia: a systematic review and meta-analysis

This meta-analysis evaluates the efficacy and safety of greenlight (PVP) and thulium laser vaporization (ThuVAP) in Benign Prostatic Hyperplasia (BPH) treatment. A systematic literature search was conducted in databases including PubMed, Cochrane Library, EMBASE, CNKI, Wangfang, and VIP in November 2023. Following the PRISMA guidelines, a systematic review and meta-analysis of the primary outcomes of interest were performed. The review was prospectively registered on PROSPERO under the registration number CRD42023491316. A total of 13 studies were included. The results of the meta-analysis showed that compared to PVP, ThuVAP had a shorter operation time (MD: 8.56, 95% CI: 4.10 ~ 13.03, p = 0.0002), and higher postoperative transfusion (OR:0.26, 95% CI: 0.10 ~ 0.64, p = 0.004). However, no significant differences were observed between the two groups in terms of length of stay (MD: -0.32, 95% CI: -0.78 ~ 0.14, p = 0.17), catherization time (MD: 0.03, 95% CI: -0.13 ~ 0.19, p = 0.73), international prostate symptom score improvement (MD: 0.23, 95% CI: -0.36 ~ 0.81, p = 0.45), quality of life improvement (MD: 0.04, 95% CI: -0.04 ~ 0.12, p = 0.29), maximum urinary flow rate improvement (MD: -0.59, 95% CI: -1.42 ~ 0.24, p = 0.16), postvoid residual urine volume improvement (MD: 1.04, 95% CI: -6.63 ~ 8.71, p = 0.79), overall postoperative complications (OR:1.15, 95% CI: 0.65 ~ 2.03, p = 0.63), postoperative bleeding (OR:1.18, 95%  CI: 0.67 ~ 2.07, p = 0.56), re-peration (OR:0.55, 95% CI: 0.16 ~ 1.95, p = 0.35), urethral stricture (OR:0.90, 95% CI: 0.46 ~ 1.75, p = 0.75), and urinary incontinence (OR:1.07, 95% CI: 0.64 ~ 1.78, p = 0.80). The results of subgroup analysis showed that the results of comparing thulium vaporesection or vapoenucleation with PVP were consistent with the results of the pooled analysis. Both greenlight and thulium laser vaporization are effective and safe, with comparable surgical and functional outcomes. The choice between these methods should be based on patient-specific factors.

A systematic review and meta-analysis of efficacy and safety comparing greenlight laser vaporization with transurethral resection of the prostate for benign prostatic hyperplasia with prostate volume less than 80 ml

We conducted a meta-analysis to evaluate the efficacy and safety of photo selective vaporisation of the prostate (PVP) with the GreenLight Laser versus transurethral resection of the prostate (TURP) for the treatment of small-volume benign prostatic hyperplasia (BPH). As of July 2022, relevant literature in online databases such as Cochrane Library, PubMed, and Embase was searched, including studies published on or before that date, and there were 9 studies in total, including 5 RCTs and 4 non-RCTs. In total 1525 patients were included to compare the efficacy of PVP and TURP in treating BPH. The Cochrane Collaboration criteria were used to evaluate the risk of bias. The software was used for random effect meta-analysis with RevMan 5.3. Data extraction included: clinical baseline characteristics, perioperative parameters, complication rates, International Prostate Symptom Score (IPSS), prostate specific antigen (PSA), post-void residual urine (PVR), maximum flow rate (Qmax), and quality of life (QoL). The pooled analysis showed that PVP was associated with reduced blood loss, blood transfusion, clot retention, catheterization time, definitive catheter removal, and hospital stay, but was associated with longer operative time and more severe dysuria (all p < 0.05). The results of this meta-analysis show that PVP as a technique for the treatment of benign prostatic hyperplasia with a volume of less than 80 cc has similar efficacy to standard TURP in IPSS, PSA, PVR, Qmax and QoL, and is an effective alternative. It outperformed TURP in terms of blood transfusion, catheterization time and hospital stay, while TURP is superior to PVP in terms of operation time.

Simple and Convenient Method for Assessing the Severity of Bleeding during Endoscopic Prostate Surgery and the Relationships between Its Corresponding Surgical Outcomes

Bleeding during endoscopic prostate surgery is often overlooked, and appropriate measurement techniques are rarely applied. We proposed a simple and convenient method for assessing the severity of bleeding during endoscopic prostate surgery. We determined the factors affecting bleeding severity and whether they affected the surgical results and functional outcomes. Records from March 2019 to April 2022 were obtained for selected patients who underwent endoscopic prostate enucleation through either 120-W Vela XL Thulium:YAG laser or bipolar plasma enucleation of the prostate. The bleeding index was measured using the following equation: irrigant hemoglobin (Hb) concentration (g/dL) × irrigation fluid volume (mL)/preoperative blood Hb concentration (g/dL) × enucleated tissue (g). Our research revealed that patients who underwent surgery employing the thulium laser, those aged over 80 years, and those with a preoperative maximal flow rate (Qmax) of more than 10 cc/s experienced less surgical bleeding. The patients' treatment outcomes differed depending on the severity of the bleeding. Enucleating prostate tissue was easier in the patients with less severe bleeding, who also had a lower risk of developing urinary tract infections and an improved Qmax.

Comparison of the efficacy and safety of transurethral laser versus open prostatectomy for patients with large-sized benign prostatic hyperplasia: A meta-analysis of comparative trials

PURPOSE

The selection of open prostatectomy (OP) over transurethral laser surgery is controversial for large volume prostates. Thus, we aim to compare the efficacy and safety of transurethral laser versus OP, and provide the latest evidence of clinical practice for large-sized benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

This meta-analysis used Review Manager V5.3 software and the systematic literature search of Cochrane Library, Embase, PubMed, and Web of Science datasets was performed for citations published from 2000 to 2020 that compared transurethral laser with OP for the treatment of large BPH. Variables of interest assessing the two techniques included clinical characteristics, and the perioperation-, effectiveness-, and complication-related outcomes.

RESULTS

The meta-analysis included twelve studies containing 1,514 patients, with 792 laser and 722 OP. The transurethral laser group was associated with shorter hospital stay and catheterization duration, and less hemoglobin decreased in the perioperative variables. There was no significant difference in the international prostate symptom score, post-void residual urine volume, maximum flow rate, and quality of life score. Transurethral laser group had a significantly lower incidence of blood transfusion than OP group (odds ratio, 0.10; 95% confidence interval, 0.05 to 0.19; p<0.001; I²=8%), and no statistical differences were found with respect to the other complications.

CONCLUSIONS

Both OP and transurethral laser prostatectomy are effective and safe treatments for large prostate adenomas. With these advantages of less blood loss and transfusion, and shorter catheterization time and hospital stay, laser may be a better choice for large BPH.

Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis

Background

Thulium laser (Tm:YAG) prostate surgery is a safe and effective procedure with low morbidity and comparable clinical outcomes to those of transurethral resection of the prostate (TURP). However, the sexual function outcomes (erectile and ejaculatory function) have been scarcely studied.

Aim

We aimed to assess the impact of Tm:YAG prostate surgery on sexual outcomes (erectile and ejaculatory function) and compare them with those patients undergoing TURP.

Material and Methods

We searched digital databases like PUBMED, SCOPUS, CENTRAL and EMBASE using relevant keywords to identify comparative studies on TURP and non-comparative studies on Tm:YAG prostate surgery that assessed sexual outcomes. We performed qualitative and quantitative analyses with the extracted data. We carried out a meta-analysis to compare postoperative International Index of Erectile Function (IIEF-5) scores and incidences of retrograde ejaculation (RE) in patients undergoing either Tm:YAG or TURP. The pre-operative and post-operative IIEF-5 scores were pooled to estimate overall scores.

Results

We included 5 comparative and 8 non-comparative studies in this review. We found the postoperative IIEF-5 score improvements to be significantly higher in the Tm:YAG prostate surgery group than in the TURP group with a significant mean difference (MD) of 0.45 (95% CI, 0.18 to 0.72; P = .001). We found no significant associations between the procedures. The pooled OR for the association of RE was estimated at 0.90 (95% CI, 0.50 to 1.60; P = .71; I² = 0%).

Conclusion

Tm:YAG prostate surgery improves erectile function more than TURP, according to our findings. Tm:YAG prostate aided surgery also outperforms TURP in terms of preserving sexual function following surgery.However, We found similar or no difference in incidence of RE between Tm:YAG prostate surgery and TURP.

Bibo L, Hao L, Pang K, et al. Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis. Sex Med 2022;10:100483.

ROS-NLRP3 signaling pathway induces sterile inflammation after thulium laser resection of the prostate

The sterile inflammation (SI) of the urinary tract is a common problem requiring serious consideration after prostatectomy. This study mainly focuses on the role of the reactive oxygen species-NLR family, pyrin domain-containing 3 (ROS-NLRP3) signaling pathway in SI after thulium laser resection of the prostate (TmLRP). Urinary cytokines were determined in patients who received TmLRP, and heat shock protein 70 (HSP70) was detected in the resected tissues. The involvement of ROS signaling in HSP70-induced inflammation was explored in THP-1 cells with or without N-acetyl- l-cysteine (NAC) pretreatment. The function of NLRP3 and Caspase-1 was determined by Western blot analysis, enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction. These phenomena and mechanisms were verified by the beagle models that received TmLRP. Clinical urine samples after TmLRP showed high expression of inflammatory factors and peaked 3-5 days after surgery. The high expression of HSP70 in the resected tissues was observed. After HSP70 stimulation, the expression of ROS, NLRP3, Caspase-1, and interleukin-18 (IL-18) increased significantly and could be reduced by ROS inhibitor NAC. The expression of IL-1β and IL-18 could be inhibited by NLRP3 or Caspase-1 inhibitors. In beagle models that received TmLRP, HSP70, NLRP3, Caspase-1, IL-1β, and IL-18 were highly expressed in the wound tissue or urine, and could also be reduced by NAC pretreatment. Activation of the ROS-NLRP3 signaling pathway induces SI in the wound after prostatectomy. Inhibition of this pathway may be effective for clinical prevention and treatment of SI and related complications after prostatectomy.

New Lasers for Stone Treatment

Laser technology has been a breakthrough in urology. The new era in endocorporeal laser lithotripsy has recently begun in mid-2020, where promising technologies tested in vitro have reached their approval for clinical use and, in that way, have made it possible to confirm their safety and advantages in the real world, for the patient and for the urologist.

Transurethral laser versus open simple prostatectomy for large volume prostates: a systematic review and meta-analysis of randomized controlled trials

The benefit of transurethral laser prostatectomy over open simple prostatectomy (OSP) is controversial in aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates, and the aim of this study is to compare the safety and efficiency of these two methods. Meta-analysis was applied using the Review Manager V5.3 software and the retrieved randomized controlled clinical trials (RCTs) comparing transurethral laser prostatectomy with OSP were analyzed for the treatment of large volume prostates from 2000 to 2019 in PubMed, Web of Science, Cochrane, and EMBASE datasets. Five RCTs assessing transurethral laser prostatectomy versus OSP were considered suitable for this meta-analysis, which included a total of 448 patients, with 232 patients undergoing laser and 216 patients undergoing OSP. Compared with OSP, although transurethral laser prostatectomy required a longer operative time (weighted mean difference (WMD) 27.49 mins; 95% confidence interval (CI) 16.54-38.44; P < 0.00001) and obtained a less resected prostate weight (WMD - 11.72 g; 95% CI - 21.75 to - 1.70; P = 0.02), patients undergoing laser prostatectomy benefited from significantly less hemoglobin decline (- 0.97 g/dL; 95% CI - 1.31 to - 0.64; P < 0.00001), shorter time of catheterization (WMD - 3.67 days; 95% CI - 5.60 to - 1.75; P = 0.0002), shorter length of hospital stay (WMD - 4.75 days; 95% CI - 6.57 to - 2.93; P < 0.00001), and less blood transfusion (odds ratio 0.10; 95% CI 0.03 to 0.35; P = 0.0003). During postoperative follow-up, no significant difference was observed between the two groups in IPSS, QoL, Q_max, and PVR. Both transurethral laser prostatectomy and OSP are safe and effective for large prostates that require prostate resection. Taking into account of less blood loss, shorter catheterization time and hospital stay, and less blood transfusion, transurethral laser prostatectomy may be a better treatment for patients with large prostates.

Lasers in Transurethral Enucleation of the Prostate-Do We Really Need Them

The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.

Epidemiology and treatment modalities for the management of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting men. BPH can lead to a number of symptoms for patients commonly referred to as lower urinary tract symptoms (LUTS). Over the last decade, increased modifiable risk factors, such as metabolic disease and obesity, have resulted in an increased incidence of BPH. This increasing incidence has brought about a multitude of treatment modalities in the last two decades. With so many treatment modalities available, physicians are tasked with selecting the optimal therapy for their patients. Current therapies can first be divided into medical or surgical intervention. Medical therapy for BPH includes 5-alpha-reductase inhibitors and alpha-blockers, or a combination of both. Surgical interventions include a conventional transurethral resection of the prostate (TURP), as well as newer modalities such as bipolar TURP, holmium laser enucleation of the prostate (HoLEP), Greenlight and thulium laser, and prostatic urethral lift (PUL). Emerging therapies in this field must also be further investigated for safety and efficacy. This narrative review attempts to consolidate current and emerging treatment options for BPH and highlights the need for additional investigation on optimizing treatment selection.

"Aquabeam® System" for benign prostatic hyperplasia and LUTS: birth of a new era. A systematic review of functional and sexual outcome and adverse events of the technique

PURPOSE

Aim of this systematic review is to evaluate functional outcomes (Qmax, QoL, IPSS, PVR), sexual outcome (erectile dysfunction and anejaculation rate), and adverse events evaluated according to the Clavien-Dindo classification.

METHODS

The bibliographic search with the included terms (prostate, benign prostatic hyperplasia, benign prostatic enlargement, lower urinary tract symptoms, water jet dissection, aquablation, Aquabeam®) produced a literature of 32 articles altogether. After removing papers of not interest or articles which the outcomes could not be deduced, nine studies were examined for a total of 664 patients screened.

RESULTS

The functional outcomes, evaluated after water jet dissection, have shown improvement with respect to the baseline in all the selected articles. In the comparison papers with the TURP, the Aquablation has been statistically not inferior regarding functional outcomes. The sexual outcomes have highlighted a better ejaculation rate for water jet dissection than TURP. Regarding the adverse events, water jet dissection documented low rates of adverse events and, in comparison studies, were not statistically superior than TURP.

CONCLUSIONS

In our systematic review, the Aquabeam® System for the treatment of LUTS/BPH has proven to be a safe technique that provides functional outcomes comparable to TURP. About sexual outcomes, the most important data is certainly the low rate of retrograde ejaculation. However, other multicenter randomized trials with larger cohorts and longer follow-up are still needed.

Outcome of thulium laser enucleation of prostate surgery in high-risk patients with benign prostatic hyperplasia

Background

Benign prostatic hyperplasia (BPH) is one of the most common diseases in aging men and a significant cause of burden worldwide. Here, we report our experience of Thulium LASER enucleation of the prostate (ThuLEP) in high-risk patients with BPH.

Methods

This was a prospective study conducted between July 2011 and June 2016. The study participants were patients with a confirmed diagnosis of BPH, who required surgery, and were clinically eligible for ThuLEP.

Results

A total of 109 patients were included in the study. Of the total 109 patients, 82 patients had American Society of Anesthesiologists (ASA) Grade 3 and 27 had ASA Grade 4. The most common comorbidity was ischemic heart diseases (72.5%), followed by hypertension (57.8%) and diabetes mellitus (48.6%). During the procedure, a total of 11 (10.1%) patients had a fall in blood pressure requiring noradrenaline or mephentine and seven (6.4%) patients had early left ventricular failure. Sixteen (14.8%) patients had arrhythmias (benign) and seven (6.4%) patients with arrhythmias required antiarrhythmic drugs. The overall duration of surgery ranged from 55 to 70 min, laser time ranged from 25 to 35 min, hospital stay ranged from 30 to 36 h, and the mean catheter time was around 24 h. Overall, the change in hemoglobin ranged from 0.5 to 0.8 g/dL.

Conclusion

Results show that ThuLEP could be a better option in high-risk patients with BPH.

Cricopharyngeal myotomy with thulium laser through flexible endoscopy: proof-of-concept study

BACKGROUND AND STUDY AIMS

Endoscopic treatment of Zenker's diverticulum has proven feasible, but electrocautery and CO ₂ laser technology carry the risk of collateral thermal injury. Thulium laser septum incision may overcome this limitation. We describe for the first time the use of thulium laser through flexible endoscopy in a small cohort of patients with Zenker diverticulum.

PATIENTS AND METHODS

Thulium laser septum division was performed via flexible endoscopy under general anesthesia in consecutive symptomatic patients with primary or recurrent Zenker diverticulum. Primary study outcomes were feasibility and safety of the procedure. A 1.9-μm laser fiber was used with an emission power of 10 - 16 W.

RESULTS

Five patients were treated between May and June 2017. Two patients presented with recurrent symptomatic diverticulum after previous transoral septum stapling. Complete division of the septum was achieved in all patients. There was no bleeding nor need of adjunctive electrocautery devices to complete the procedure. The postoperative course was uneventful in all patients; the chest film and gastrographin swallow study on postoperative Day 1 were negative for pneumomediastinum, leaks or residual pouch. All patients were discharged within 48 hours on a soft diet. At the 1- and 3-month follow-up visits, all patients were satisfied with the procedure and reported improved swallowing and absence of regurgitation and cough.

CONCLUSIONS

Division of Zenker's septum with thulium laser is feasible and safe through flexible endoscopy. Longer-term follow-up is required to establish efficacy and effectiveness of this novel procedure.

Comparative study between thulium laser (Tm: YAG) 150W and greenlight laser (LBO:ND-YAG) 120W for the treatment of benign prostatic hyperpplasia: Short-term efficacy and security

OBJECTIVE

To compare the results of efficacy and safety of Thulium laser 150W against Greenlight laser 120W in the treatment of short term benign prostatic hyperplasia (12 months after surgery).

MATERIAL AND METHODS

This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow <15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out.

RESULTS

116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P>.05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P=.41); in readmissions, 2.6% with thulium and 1.7% with green laser (P=.68); in need for transfusion, 2.6% with thulium and 0% with green laser (P=.12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P=.28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P=.75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P=.65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78±2.09 and with green laser 1.83±1.48 (P=.75).

CONCLUSIONS

Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques.

Two-micrometer thulium laser resection of the prostate-tangerine technique in benign prostatic hyperplasia patients with previously negative transrectal prostate biopsy

The 2-μm thulium laser resection of the prostate-tangerine technique (TmLRP-TT) has been introduced as a minimally invasive treatment for benign prostatic hyperplasia (BPH). This study was undertaken to assess the clinical efficacy and safety of TmLRP-TT for the treatment of BPH patients with previously negative transrectal prostate biopsy. A prospective analysis of 51 patients with previously negative transrectal prostate biopsy who underwent surgical treatment using TmLRP-TT was performed from December 2011 to December 2013. Preoperative status, surgical details, and perioperative complications were recorded. The follow-up outcome was evaluated with subjective and objective tests at 1 and 6 months. TmLRP-TT was successfully completed in all patients. Mean prostate volume, operative duration, and catheterization time were 93.3 ± 37.9 ml, 69.5 ± 39.5 min, and 6.5 ± 1.3 days, respectively. The mean International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and post-void residual urine volume changed notably at 6-month follow-up (22.5 ± 6.9 vs 6.1 ± 3.2, 4.8 ± 1.3 vs 1.1 ± 0.9, 7.3 ± 4.5 vs 18.9 ± 7.1 ml s⁻¹, and 148.7 ± 168.7 vs 28.4 ± 17.9 ml). Two (3.9%) patients required blood transfusion perioperatively, while 3 (5.9%) patients experienced transient hematuria postoperatively, and 2 (3.9%) patients received 3 days recatheterization due to clot retention. TmLRP-TT is a safe and effective minimally invasive technique for patients with previously negative transrectal prostate biopsy during the 6-month follow-up. This promising technology may be a feasible surgical method for previously negative transrectal prostate biopsy in the future.

The efficacy and safety of 2-μm continuous laser in the treatment of high-risk patients with benign prostatic hyperplasia

Two-micrometer laser resection of prostate-tangerine technique dissects whole prostatic lobes off the surgical capsular, similar to peeling a tangerine. The present study aimed to evaluate the safety and efficacy of 2-μm continuous laser vaporization in the treatment of high-risk patients with benign prostatic hyperplasia (BPH) during the 24-month follow-up. The study included 248 patients with moderate to severe lower urinary tract symptoms who underwent 2-μm continuous laser vaporization of the prostate. All patients were accompanied with different degree comorbidities and 94 patients were taking oral anticoagulants. BPH was successfully treated with 2-μm continuous laser vaporization in all patients. Mean pre-operative prostate volume was 76 ± 25.3 ml and mean operative time was 49.8 ± 16.5 min. There were no major complications intra-operatively or postoperatively, and no blood transfusions were needed. About 20 patients (8.1%) needed bladder irrigation postoperatively. Average catheterization time was 2.0 ± 1.8 days (range 1-5 days). Four patients required reoperation due to enlarged prostates from residual adenoma. At 3-, 6-, 12-, and 24-month follow-ups, maximum urinary flow rates (Qmax) increased from 6.9 ± 1.7 to 19.1 ± 4.2, 19.5 ± 4.6, 19.4 ± 4.6, and 19.5 ± 4.1 ml/s, respectively. Mean International Prostate Symptom Scores (IPSS) decreased from 27.6 ± 5.1 (pre-operation) to 9.2 ± 2.6, 7.12 ± 1.42, 6.18 ± 1.32, and 6.25 ± 1.30 at 3-, 6-, 12-, and 24-month post-operation, respectively. Two-micrometer continuous laser vaporization is a safe and effective surgical endoscopic technique associated with low complication rate in BPH patients at high risk and those on anticoagulation therapy who have severe LUTS caused by BPH.