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Romero Otero J, Justo Quintas J, García Gómez B, Manfredi C, Sopeña Sutil R, Peña Vallejo E, Lista Mateos F, Bozzini G, Rodríguez Antolín A, García Rojo E. Prospective randomized multicenter study to evaluate holmium vs. new thulium fiber laser for prostate enucleation. Minerva Urol Nephrol 2024; 76:491-498. [PMID: 39051894 DOI: 10.23736/s2724-6051.24.05706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) commonly causes lower urinary tract symptoms (LUTS) in men. Holmium (HoLEP) and thulium (ThuLEP) laser enucleation are established techniques for BPH treatment. Thulium fiber laser (TFL) for prostate enucleation (ThuFLEP) shows promising outcomes. METHODS A prospective randomized multicenter study was conducted. Patients with BPH and LUTS unresponsive to medical therapy were enrolled. Preoperative, surgical, perioperative and postoperative data were recorded with follow-up at 3 and 6 months. The primary outcome was functional improvement, and the secondary outcome was safety in terms of complications. RESULTS Two hundred patients were included (HoLEP 100, ThuFLEP 100). No significant baseline difference was found between groups. At 3 and 6 months we found statistically significant improvements from baseline for both HoLEP and ThuFLEP in efficacy: International Prostatic Symptoms Score (IPSS), IPSS-Quality of Life (QoL), maximum urinary flow rate (Qmax), and post-void residual volume (PVR; P<0.05). At 6 months, mean±SD IPSS, IPSS-QoL, Qmax, and PVR for HoLEP vs. ThuFLEP were 5.8±4.9 vs. 4.8±5.0 points (P=0.57), 1.6±1.4 vs. 0.7±1.1 points (P=0.09), 29.9±12.5 vs. 29.6±8.0 mL/s (P=0.8), and 16.3±17.7 vs. 15.5±13.4 mL (P=0.92), respectively. No intraoperative complication was recorded. No Clavien-Dindo ≥III complications occurred during hospitalization. After 6 months, 8 (8%) and 6 (6%) patients reported mild stress urinary incontinence in HoLEP and ThuFLEP groups, respectively (P=0.24). Urethral stenosis was observed in 3 men (3%) in the HoLEP group and 1 subject (1%) in the ThuFLEP group (P=0.72). CONCLUSIONS HoLEP and ThuFLEP are effective and safe for BPH treatment, with comparable functional outcomes and complication rates at 6 months. Further research is needed to confirm these findings.
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Affiliation(s)
- Javier Romero Otero
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain -
| | - Juan Justo Quintas
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Borja García Gómez
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Raquel Sopeña Sutil
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Elena Peña Vallejo
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Fernando Lista Mateos
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Giorgio Bozzini
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Alfredo Rodríguez Antolín
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Esther García Rojo
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
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Al Barajraji M, Moussa I, Soscia GL, Naudin M, Lempereur L, Coscarella M. Evaluation of the learning curve for Thulium fiber laser enucleation of prostate (ThuFLEP): retrospective study of a single-surgeon experience in real-world settings. World J Urol 2024; 42:444. [PMID: 39060790 DOI: 10.1007/s00345-024-05167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE To assess the learning curve of Thulium Fiber Laser Enucleation of prostate (ThuFLEP) of a single surgeon inexperienced in laser endoscopic enucleation of prostate (EEP). METHODS We retrospectively analyzed all patients with benign prostate hyperplasia undergoing ThuFLEP at our center between January 2022 and August 2023 by one surgeon. Inclusion criteria were International Prostate Symptom Score > 7, prostate volume < 200 g, and maximal urinary flow rate < 15 mL/s. The surgeon was inexperienced in laser EEP and trained by watching educational videos of ThuFLEP before starting to perform the procedure under mentoring during the first 4 cases. Procedural data (enucleation and morcellation efficiency, complications) and functional results up to 3 months were evaluated. Patients were divided into 4 cohorts of 20 consecutive cases to evaluate outcomes evolution throughout time. RESULTS The mean age of the patients was 69.9 years (SD 7.8) and mean prostate volume was 89.9 g (SD 25.8). Preoperative functional parameters were comparable between the groups. Mean enucleation efficiency (EE) ratio and morcellation efficiency (ME) ratio reached respectively 0.78 g/min (SD 0.55) and 2.49 g/min (SD 1.03) and both variables significantly increased from group 1 to group 3 (p < 0,001). Perioperative complications remained low throughout the caseload with similar significant 3-month functional improvements between all groups. CONCLUSION This is the first study to evaluate ThuFLEP learning curve for a single surgeon inexperienced in laser EEP with limited mentoring. Under these real-world conditions, nearly 60 cases were needed to complete the learning curve with a complications rate remaining low throughout the training process.
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Affiliation(s)
- Moncef Al Barajraji
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium.
| | - Ilan Moussa
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Gian-Luca Soscia
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Louise Lempereur
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Mathieu Coscarella
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, Brussels, Belgium
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Aybal HC, Yilmaz M, Barlas IS, Duvarci M, Tuncel A, Tunc L. Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis. World J Urol 2024; 42:374. [PMID: 38871959 DOI: 10.1007/s00345-024-05082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE 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). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | - Mehmet Yilmaz
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany.
| | - Irfan Safak Barlas
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Mehmet Duvarci
- Department of Urology, University of Health Sciences, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Altug Tuncel
- Ankara Bilkent City Hospital, Department of Urology, University of Health Sciences, Ankara, Turkey
| | - Lutfi Tunc
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
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Romero Otero J, Justo Quintas J, García Rojo E, Sopeña Sutil R, Peña Vallejo E, Lista Mateos F, Bozzini G, Saenz Calzada D, Rodríguez Antolín A, García Gómez B. Initial experience with thulium fiber laser for prostate enucleation: Analysis of the intraoperative and short-term outcomes in a prospective, multicenter cohort. Actas Urol Esp 2024; 48:371-376. [PMID: 38369292 DOI: 10.1016/j.acuroe.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate. MATERIAL AND METHODS All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications. RESULTS Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤2, according to the Clavien-Dindo classification. DISCUSSION With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data. CONCLUSIONS TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.
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Affiliation(s)
- J Romero Otero
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain.
| | - J Justo Quintas
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - E García Rojo
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - R Sopeña Sutil
- Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
| | - E Peña Vallejo
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain
| | - F Lista Mateos
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain; Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
| | - G Bozzini
- Servicio de Urología, Hospital Sant'Anna, San Fermo della Battaglia, Como, Italy
| | - D Saenz Calzada
- Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales y ROC Clinic, Móstoles, Madrid, Spain
| | - A Rodríguez Antolín
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain
| | - B García Gómez
- Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
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Becker B, Hook S, Gross AJ, Rosenbaum C, Filmar S, Herrmann J, Netsch C. [Thulium or holmium laser or both: where will the journey take us?]. Aktuelle Urol 2024; 55:236-242. [PMID: 38604230 DOI: 10.1055/a-2286-1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The Holmium:YAG laser has been the gold standard for laser lithotripsy over the past three decades and, since the late 1990s, also for prostate enucleation. Pulsed thulium fibre lasers (TFL) demonstrated their efficacy in in-vitro experiments and were introduced to the market a few years ago. Initial clinical results for TFL in lithotripsy and enucleation are very promising. In addition to TFL, a pulsed Thulium:YAG solid-state laser has been introduced, but clinical data for this laser are currently limited. This article aims to review the key technological differences between Ho:YAG lasers and pulsed thulium lasers and compare/discuss the initial clinical results for stone lithotripsy and laser enucleation.In-vitro studies have demonstrated the technical superiority of TFL compared with Ho:YAG lasers. However, as TFL is still a new technology, only limited studies are available to date, and optimal settings for lithotripsy have not been established. For enucleation, the differences of TFL compared with a high-power Ho:YAG laser seem to be clinically irrelevant. Initial studies on pulsed Tm:YAG lasers show good results, but there continues to be a lack of comparative studies.Based on the current literature, pulsed thulium lasers have the potential of being an alternative to Ho:YAG lasers. However, further studies are necessary to determine the optimal laser technology for enucleation and lithotripsy of urinary stones, considering all parameters, including efficacy, safety, and cost.
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Affiliation(s)
- Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Sophia Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Simon Filmar
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Jonas Herrmann
- Urologie und Urochirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
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Castellani D, Enikeev D, Gokce MI, Petov V, Gadzhiev N, Mahajan A, Maheshwari PN, Fong KY, Tursunkulov AN, Malkhasyan V, Zawadzki M, Sofer M, Cormio L, Busetto GM, Somani BK, Herrmann TR, Gauhar V. Influence of Prostate Volume on the Incidence of Complications and Urinary Incontinence Following Thulium Fiber Laser Enucleation of the Prostate: Results from Multicenter, Real-world Experience of 2732 patients. EUR UROL SUPPL 2024; 63:38-43. [PMID: 38558764 PMCID: PMC10981004 DOI: 10.1016/j.euros.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Background The use of the new thulium fiber laser in enucleation of the prostate (ThuFLEP) has been introduced recently. Objective To evaluate complications and urinary incontinence (UI) after ThuFLEP in small and large prostate volume (PV). Design setting and participants We retrospectively reviewed patients who underwent ThuFLEP in six centers (from January 2020 to January 2023). The exclusion criteria were concomitant lower urinary tract surgery, previous prostate/urethral surgery, prostate cancer, and pelvic radiotherapy. Outcome measurements and statistical analysis Patients were divided into two groups: group 1: PV ≤80 ml; group 2: PV >80 ml. Univariable and multivariable logistic regression analyses were performed to evaluate the independent predictors of overall UI. Results and limitations There were 1458 patients in group 1 and 1274 in group 2. There was no significant difference in age. The median PV was 60 (61-72) ml in group 1 and 100 (90-122) ml in group 2. En bloc enucleation was employed more in group 1, while the early apical release technique was used more in group 2. The rate of prolonged irrigation for hematuria, urinary tract infection, and acute urinary retention did not differ significantly. Blood transfusion rate was significantly higher in group 2 (0.5% vs 2.0%, p = 0.001). There was no significant difference in the overall UI rate (12.3% in group 1 vs 14.7% in group 2, p = 0.08). A multivariable regression analysis showed that preoperative postvoiding urine residual (odds ratio 1.004, 95% confidence interval 1.002-1.007, p < 0.01) was the only factor significantly associated with higher odds of UI. A limitation of this study was its retrospective nature. Conclusions Complications and UI rates following ThuFLEP were similar in patients with a PV up to or larger than 80 ml except for the blood transfusion rate that was higher in the latter. Patient summary In this study, we looked at outcomes after thulium fiber laser in enucleation of the prostate stratified by PV. We found that blood transfusion was higher in men with PV >80 ml, but urinary incontinence was similar.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Abhay Mahajan
- Sai Urology Hospital and Mahatma Gandhi Mission’s Medical College and Hospital, Aurangabad, India
| | | | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vigen Malkhasyan
- Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | | | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Luigi Cormio
- Andrology and Urology Unit, Bonomo Teaching Hospital, Andria, Italy
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
- Hannover Medical School, Hannover, Germany
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Spinos T, Tatanis V, Peteinaris A, Somani B, Kartalas Goumas I, Liatsikos E, Kallidonis P. Thulium fiber laser enucleation of the prostate: a systematic review of the current outcomes. Minerva Urol Nephrol 2024; 76:157-165. [PMID: 38742551 DOI: 10.23736/s2724-6051.24.05654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
INTRODUCTION One recent addition to different lasers used for endoscopic enucleation of the prostate is the thulium fiber laser (TFL). The purpose of this systematic review is to present the feasibility, safety and efficacy of TFL Enucleation of the Prostate (ThuFLEP). EVIDENCE ACQUISITION PubMed®, Scopus® and Cochrane® primary databases were systematically screened. The search strategy used the PICO (Patients, Intervention, Comparison, Outcome) criteria. Patients should be adults with benign prostatic obstruction (BPO) undergoing ThuFLEP. While comparative studies reporting comparison of ThuFLEP to other BPO treatments were included, cohort studies with no comparison group were also accepted. Outcomes including enucleation time and complication rates were reported. EVIDENCE SYNTHESIS Twelve studies met all the predefined criteria and were included in the final qualitative synthesis. Mean operative time and enucleation time ranged from 46.6±10.2 to 104.5±33.6 and from 38.8±17.9 to 66.0±24.9 minutes, respectively. Most of the complications were Grade I or Grade II ones. Although TFL was found to present some advantages over older BPO treatments, its outcomes were comparable with other endoscopic enucleation approaches. CONCLUSIONS ThuFLEP seems to be a feasible, safe and efficient approach for BPO symptoms management. Limited evidence showed that although ThuFLEP was associated with a reduced total operative time, it was also associated with worse IPSS improvement at 1-year follow-up, when compared with MOSESTM Holmium Laser Enucleation of the Prostate (HoLEP). These findings confirm the well-established opinion that the enucleation technique itself is more important than the technology which is used.
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Affiliation(s)
- Theodoros Spinos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | - Bhaskar Somani
- Department of Urology, University Hospital of Southampton, Southampton, UK
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Kamalov AA, Sorokin NI, Dzitiev VK, Strigunov AA, Nesterova OY, Bondar IV. Propensity score-matched analysis comparing perioperative, functional, and safety outcomes between thulium fiber laser and bipolar enucleation of the prostate performed by a single surgeon with two years of follow-up. Investig Clin Urol 2024; 65:139-147. [PMID: 38454823 PMCID: PMC10925738 DOI: 10.4111/icu.20230270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/28/2023] [Accepted: 11/13/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (ThuFLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis. MATERIALS AND METHODS Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release. RESULTS Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar. CONCLUSIONS ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia.
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Affiliation(s)
- Armais Albertovich Kamalov
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Nikolay Ivanovich Sorokin
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Vitaly Kazichanovich Dzitiev
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Andrey Alekseevich Strigunov
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Olga Yurevna Nesterova
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation.
| | - Ilya Vladimirovich Bondar
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation
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Kosiba M, Filzmayer M, Welte MN, Hügenell L, Keller AC, Traumann MI, Müller MJ, Kluth LA, Mandel PC, Chun FKH, Becker A. Thulium fiber laser vs. holmium laser enucleation of the prostate: results of a prospective randomized non-inferiority trial. World J Urol 2024; 42:49. [PMID: 38244076 PMCID: PMC10799774 DOI: 10.1007/s00345-023-04748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Holmium laser enucleation of the prostate (HoLEP) represents the current standard procedure for size-independent surgical therapy of benign prostatic obstruction (BPO). With advent of the novel laser technology thulium fiber laser (TFL), we hypothesized that the functional outcome of TFL enucleation of the prostate (ThuFLEP) is non-inferior compared to HoLEP. METHODS From October 2021 to October 2022, 150 patients with BPO were recruited for the prospective randomized trial in accordance with CONSORT. Stratified randomization into the arms ThuFLEP (n = 74) or HoLEP (n = 76) was carried out. The primary endpoint was non-inferior international prostate symptom score (IPSS) and quality of life (QoL) at three months after treatment. Secondary endpoints were rates of complications, peak flow, residual urine and operation times. RESULTS Preoperative characteristics showed no significant differences. Overall IPSS and QoL improved from 21 to 8 and 4 to 1.5, respectively, after three months of follow-up. No statistically significant differences between ThuFLEP and HoLEP were observed regarding median postoperative IPSS (8.5 vs. 7, p > 0.9), QoL (1 vs. 2, p = 0.6), residual urine (48 vs. 30ml, p = 0.065) and peak flow (19 vs. 17ml/s, p > 0.9). Similarly, safety profile was comparable with no statistically significant differences regarding rate of major complications (5.3 vs. 5.4%, p = 0.5), laser hemostasis time (3 vs. 2min, p = 0.2), use of additive electric coagulation (74 vs. 87%, p = 0.06) or electric coagulation time (8 vs. 8min, p = 0.4). CONCLUSIONS In this prospective, randomized trial ThuFLEP showed non-inferior results compared to HoLEP in terms of functional outcomes measured by IPSS and QoL as primary endpoint. TRIAL REGISTRATION NUMBER DRKS00032699 (18.09.2023, retrospectively registered).
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Affiliation(s)
- Marina Kosiba
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Maximilian Filzmayer
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany.
| | - Maria N Welte
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Leonie Hügenell
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Anna C Keller
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Miriam I Traumann
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Matthias J Müller
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Luis A Kluth
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Philipp C Mandel
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Felix K-H Chun
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
- Urological Center at Boxberg, Neunkirchen, Germany
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10
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Gauhar V, Nedbal C, Castellani D, Fong KY, Sofer M, Socarrás MR, Tursunkulov AN, Ying LK, Elterman D, Mahajan A, Petov V, Ivanovich SN, Bhatia TP, Enikeev D, Gadzhiev N, Chiruvella M, Teoh JYC, Galosi AB, Sancha FG, Somani BK, Herrmann TRW. Comparison Between Thulium Fiber Laser and High-power Holmium Laser for Anatomic Endoscopic Enucleation of the Prostate: A Propensity Score-matched Analysis from the REAP Registry. Eur Urol Focus 2024; 10:182-188. [PMID: 37414615 DOI: 10.1016/j.euf.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Different lasers have been developed for treatment of benign prostatic hyperplasia, with no definitively superior technique identified to date. OBJECTIVE To compare surgical and functional enucleation outcomes in real-world multicentre practice using high-power holmium laser (HP-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) for different prostate sizes. DESIGN, SETTING, AND PARTICIPANTS The study included 4216 patients who underwent HP-HoLEP or ThuFLEP at eight centers in seven countries between 2020 and 2022. Exclusion criteria were previous urethral or prostatic surgery, radiotherapy, or concomitant surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To adjust for the bias arising from different characteristics at baseline, propensity score matching (PSM) was used to identify 563 matched patients in each cohort. Outcomes included the incidence of postoperative incontinence, early complications (30-d), and delayed complications, and results for the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual volume (PVR). RESULTS AND LIMITATIONS After PSM, 563 patients in each arm were included. Total operative time was similar between the arms, but enucleation and morcellation times were significantly longer for ThuFLEP. The rate of postoperative acute urinary retention was higher in the ThuFLEP arm (3.6% vs 0.9%; p = 0.005), but the 30-d readmission rate was higher in the HP-HoLEP arm (22% vs 8%; p = 0.016). There was no difference in postoperative incontinence rates (HP-HoLEP:19.7%, ThuFLEP:16.0%; p = 0.120). Rates of other early and delayed complications were low and comparable between the arms. The ThuFLEP group had higher Qmax (p < 0.001) and lower PVR (p < 0.001) than the HP-HoLEP group at 1-yr follow-up. The study is limited by its retrospective nature. CONCLUSIONS This real-world study shows that early and delayed outcomes of enucleation with ThuFLEP are comparable to those with HP-HoLEP, with similar improvements in micturition parameters and IPSS. PATIENT SUMMARY As lasers become readily available for the treatment of enlarged prostates causing urinary bother, urologists should focus on performing good anatomic removal of prostate tissue, with the choice of laser not as important for good outcomes. Patients should be counseled about long-term complications, even when the procedure is being performed by an experienced surgeon.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Carlotta Nedbal
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy; Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Lie Kwok Ying
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India
| | - Vladislav Petov
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India
| | - Dmitry Enikeev
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Vienna Medical University, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
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11
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Kronenberg P, Cerrato C, Juliebø-Jones P, Herrmann T, Tokas T, Somani BK. Advances in lasers for the minimally invasive treatment of upper and lower urinary tract conditions: a systematic review. World J Urol 2023; 41:3817-3827. [PMID: 37906263 DOI: 10.1007/s00345-023-04669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE Technological advancements in laser lithotripsy are expanding into numerous fields of urology, like ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and benign and malignant soft-tissue treatments. Since the amount of research regarding lasers in urology has grown exponentially, we present a systematic review of the most recent and relevant advances encompassing all lasers used in urological endoscopic treatment. METHODS We performed a literature search using PubMed (May 2023) to obtain information about lasers for urological purposes. We included only recent data from published articles between 2021 and 2023 or articles ahead of print. RESULTS Lasers are widely used in lithotripsy for ureteric, renal, and bladder stones, benign prostate surgery, and bladder and upper tract tumor ablation. While the holmium (Ho:YAG) laser is still predominant, there seems to be more emphasis on pulse modulation and newer lasers such as thulium fiber laser (TFL) and pulsed Tm:YAG laser. CONCLUSION The use of lasers and related technological innovations have shown increasing versatility, and over time have proven to be invaluable in the management of stone lithotripsy, treatment of benign and malignant prostate diseases, and urothelial tumors. Laser endoscopic treatment is heavily based on technological nuances, and it is essential to know at least the basics of these technologies. Ultimately the choice of laser used depends on its availability, cost, surgeon experience and expertise.
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Affiliation(s)
| | - Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Thomas Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
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12
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Castellani D, Di Rosa M, Gómez Sancha F, Rodríguez Socarrás M, Mahajan A, Taif Bendigeri M, Taratkin M, Enikeev D, Dellabella M, Gadzhiev N, Somani BK, Herrmann TRW, Gauhar V. Holmium laser with MOSES technology (MoLEP) vs Thulium fiber laser enucleation of the prostate (ThuFLEP) in a real-world setting. Mid-term outcomes from a multicenter propensity score analysis. World J Urol 2023; 41:2915-2923. [PMID: 37515650 DOI: 10.1007/s00345-023-04524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/04/2023] [Indexed: 07/31/2023] Open
Abstract
PURPOSE To compare Holmium laser with MOSES technology (MoLEP) and Thulium fiber laser enucleation of the prostate (ThuFLEP) in terms of surgical and functional outcomes. METHODS We performed a retrospective analysis of all patients who underwent either procedure in five centers (January 2020-January 2022). EXCLUSION CRITERIA previous urethral/prostatic surgery, radiotherapy, concomitant surgery. Propensity score matching (PSM) analysis was performed to adjust for the bias inherent to the different characteristics at baseline. Differences between procedures were estimated using Firth Penalized Likelihood regression for International prostate symptom score (IPSS), quality of life (QL), maximum flow rate (Qmax). RESULTS PSM retrieved 118 patients in each group. Baseline characteristics were similar except for PSA and number of men on indwelling catheter (higher in MoLEP group). Median surgical time was significantly longer in the MoLEP group despite the enucleation and morcellation times being similar. Median catheter dwelling time and postoperative length of stay were similar. Most of the early complications were Clavien ≤ 2 grade. There were only two Clavien grade 3 complications (one for each group), one grade 4 in MoLEP group. Rate and type of early and persistent incontinence (> 3 months) were similar. At 12-month, proportion of patients reaching a decrease (Δ) of IPSS ≥ 18 from baseline was significantly larger in MoLEP group, with no significant difference in ΔQmax > 12 ml/sec and ΔQL ≥ -3. CONCLUSION MoLEP and ThuFLEP were safe and efficacious procedures with similar short-term operative and functional outcomes. At 1-year, MoLEP patients had a sustained reduction of IPPS score.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, IRCCS INRCA, Ancona, Italy
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica Delle Marche, Ancona, Italy
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, Center for Biostatistic and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Via Santa Margherita 5, 60124, Ancona, Italy.
| | | | | | - Abhay Mahajan
- Department of Urology, Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | | | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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