V02-05: Thulium Fiber Laser Enucleation of the Small Glands (< 80 cc)
Monopolar transurethral resection of the prostate (TURP) is the treatment of choice and most frequently performed surgery for prostate glands over 80 cc. Thulium fiber laser enucleation of the prostate (ThuFLEP) is a less invasive treatment option for BPH due to minimal penetration of laser energy (0.2 mm) and tissue coagulation. The aim of our study was to compare the efficacy of TURP and ThuFLEP in management of BPH in patients with small prostate glands (<80 cc).</p>
This retrospective study included 398 patients with prostate volume less than 80 cc aged 66.1 (54-82) years with infravesical obstruction (IPSS>20, Qmax<12) due to BPH. Group A (140 patients) underwent ThuFLEP (mean prostate volume, 65.9 cc) and group B (258 patients) underwent TURP (mean prostate volume, 63.3 cc). Patients with urethral strictures, bladder stones or a history of prior prostate surgery were excluded. For enucleation, we used Urolase (NTO IRE-POLUS, Russia), a 120 W thulium fiber laser, and a 600 µm fiber. Tissue removal from the bladder was performed with a Piranha morcellator (Richard Wolf, Germany). Prior to and following surgery, serum sodium and hemoglobin levels were assessed. Preoperatively and six months after surgery we evaluated IPSS, QoL, Qmax and post-void residual volume. A p-value of 0.05 was chosen as a threshold for statistical significance.</p>
Mean surgery time in the ThuFLEP group was higher (48.1±17.6 min) than in the TURP group (37.9±18.6 min) (p<0.001). Mean mass of removed tissue was 54.0 g in group ? and 49.4 g in group B. Catheterization time was 1.4 days in group A and 2.4 days in group B. Hospital stay was 3.4 days in group A and 4.7 days in group B. Stress urinary incontinence following catheter removal was observed in 7.9% of cases in group A and in 14.4% of cases in group B (p=0.256). Hemoglobin level decreased by an average of 1.01 g/dL in group A and 1.8 g/dL in group B (p<0.001). Similarly, serum sodium level decreased by an average of 1.1 mmol/L in group A and 4.1 mmol/L in group B (p<0.001). Postoperative bleeding necessitating blood transfusion and TURP-syndrome were noted in 1 patient (0.4%) after TURP. Six months after surgery, we observed statistically significant improvement in IPSS, QoL, Qmax and post-void residual volume in all the patients (p<0.001). There were no differences in the above mentioned parameters between the two groups.</p>
Despite taking longer to perform, ThuFLEP for BPH in patients with small prostate glands (>80 cc) offered improvement in voiding parameters – comparable to those after TURP – while at the same time showing decreased postoperative complication rates.