V8-09: THULIUM VAPOENUCLEATION OF THE PROSTATE

Video

Introductions and Objectives
Thulium VapoEnucleation (ThuVEP) has been studied in Asia and Europe and has been shown to be safe and effective even for larger prostates. The aim of this study was to describe initial experience with this technique in a North American (NA) patient population.

Methods
From December 2010 to September 2013, 18 men underwent ThuVEP using the CyberTM® laser. We performed a retrospective chart review of patient demographics, comorbidities, intraoperative parameters, complications, lab values, and post-operative outcomes including maximum flow rate(Qmax), post-void residual(PVR), International Prostate Symptom Score(IPSS), and quality of life(QoL) score. Patients were evaluated at 1, 3, 6, and 12 months. Statistical analysis was done using Wilcoxon signed ranks test.

Results
Mean age was 71±9 years and prostate size 127±68 cc’s. Baseline mean IPSS was 20±10, QoL 5±2, PVR 428±282 mL, PSA 6.8±5.2 and Qmax 1.6±2.3 mL/s. Indications for surgery included retention in 15(83%). Median Charlson Comorbidity Index was 5(IQR 4-5.75) and 10(56%) of patients were on anticoagulation. Mean laser time and energy used were 54±24min and 285±149kJ. Mean operative time was 180 ±74min. Mean change in hemoglobin(Hb) was -0.7±0.9 g/dL. No significant change in mean serum sodium was seen (-0.7±0.4mmol/L, P=0.58). Most patients went home the day of surgery with mean hospital stay 1±1day. Mean catheter time was 5 ±3days. Complications occurred in 2(11%) patients. 1 patient developed clot retention requiring catheterization and bedside irrigation. 1 patient with cardiac comorbidity had blood transfusion for anemia, although preoperative and postoperative Hb’s were 8.4 and 8.8 g/dL. Improvements were seen in Qmax, PVR, IPSS, and QoL score at each time interval. Of 15 patients that initially presented in urinary retention, all with follow-up were voiding at last visit.

Conclusions
In this initial NA study, ThuVEP appears to be a safe and effective treatment for BPH, even in patients with large prostates and high comorbidity. There were few complications, minimal hospitalization, and outcomes were durable to 12 months. Longer follow-up and larger numbers are necessary to confirm these findings.

Funding: None