Monopolar Versus Laser (ThuFLEP, HoLEP) Endoscopic Enucleation of the Prostate: A Single-center Experience
The aim of our study was to compare the efficacy and functional outcomes of three different techniques of endoscopic enucleation of the prostate including monopolar enucleation, holmium laser enucleation (HoLEP), and thulium fiber laser enucleation (ThuFLEP).
After approval by the Institutional Review Board committee, we performed retrospective assessment of pre- and postoperative parameters of 551 male patients aged 54 to 87 years(IPSS>20; Qmax<10). Patients with a history of prior prostate surgery, urethral strictures or bladder stones were excluded. Monopolar enucleation was performed with a monopolar electrosurgical generator, hook-electrode and straight loop. For HoLEP, we used VersaPulse (Lumenis, Israel) with a 550 μm laser fiber. For ThuFLEP, we used thulium fiber laser Urolase (NTO IRE-POLUS, Russia) and a 600 μm fiber. Functional parameters were evaluated prior to surgery and 6 month after (IPSS, QoL, Qmax, PVR).</p>
HoLEP was performed on 254 patients, monopolar enucleation - on 95 patients and ThuFLEP - on 202 patients. The mean mass of morcellated tissue did not differ significantly between techniques (p>0.05). However, the mean ThuFLEP (71.6±26.7 min) and mean HoLEP (75.9±35.3 min) times were shorter than monopolar enucleation (95.9±38.3 min) time (p<0.05). The mean catheterization time following laser interventions was shorter (HoLEP - 31.2 h; ThuFLEP - 31.1 h) compared to monopolar enucleation (74.4 h). Hospital stay: HoLEP - 3.3 days, ThuFLEP - 3.4 days, monopolar enucleation - 7.9 days. Patients after monopolar enucleation had a significant decrease in postoperative hemoglobin and sodium levels (p<0.05). Two instances of postoperative complications were observed: one case of postoperative bleeding that required transfusion (1.1%) and one case of TUR-syndrome (1.1%) after monopolar enucleation. Urinary tract infection rates were 1.0-2.0% in all techniques. In 1% of cases in all three techniques, we noted bladder tamponade. Clot retention after HoLEP was observed in 4.7%, after ThuFLEP - in 4.4% and after monopolar enucleation - in 8.4%. Six months after surgery, all the groups showed statistically significant improvement in voiding parameters (p<0.05) with no significant difference between techniques (p>0.05).
Both laser enucleation techniques proved to be efficacious in the management of BPH. Monopolar enucleation of the prostate seems to be a highly promising addition to the list of enucleation techniques. It is an effective and acceptable procedure, despite having a higher complication rate.