Transurethral Thulium laser resection of prostate vs monopolar transurethral resection – evaluation of postoperative outcomes

Abstract

Introduction. Treatment of benign prostatic hyperplasia (BPH) remains one of the actual problems in endourology. Currently, monopolar TUR-P remains the gold standard in the surgical treatment of BPH. Nowadays laser technologies offer safe and efficient alternatives in BPH endourologic treatment. Aim of the study. Comparative assessment of the efficacy of transurethral Thulium laser resection of prostate. Materials and methods. In the period of 08.2017 – 02.2018, 52 patients with average age of 62 years underwent endourologic treatment of BPH at the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy. Patients were divided into two treatment groups: transurethral Thulium resection of prostate (24 patients) and monopolar TUR-P (28 patients), and evaluated postoperatively after 1 month. Preoperative patients were investigated: PSA, IPSS, QoL, TRUS-P with PVR and Qmax. Patients inclusion criteria: prostate volume 40 - 70cm3, IPSS ≥16 and PVR ≥ 50ml, PSA≤4ng / ml, QoL> 4, Qmax <8ml/s. Results. Average duration of intervention: 63 min vs 47 min. The prostate volume decreased postoperatively on average from 58.4 cm3 to 26.1 cm3, vs 61.1 cm3 to 24.6 cm3, there was an increase of average Qmax from 7.3 to 20.7 ml/s vs 7,5 to 21.2 ml/s, a decrease in mean IPSS from 20.3 to 4.3 vs 21 to 4.5, and a PVR decrease from 65.2 ml to 15.5 ml vs 68.6 to 16.8 ml, respectively. The period of transitional macrohaematuria was 1.2 days vs 2.3 days respectively. The duration of catheterization was 1.5 days in the first group and 2.6 days in the second group. The complication rate was similar. Conclusions. Transurethral Thulium laser resection of prostate is an effective alternative method in the treatment of BPH. Immediate postoperative results of Thulium laser prostate resection are similar to the results of the “gold standard” – monopolar TUR-P group. The high safety profile characteristic for Thulium laser resection of prostate is also to be mentioned.