Transurethral Thulium laser vapoenucleation of prostate – a good alternative for open surgery

Abstract

Introduction. Treatment of huge benign prostatic hyperplasia (BPH) consists an actual problem for urological community. Nowadays, open surgery is one of the basic surgical methods in treatment of large BPH, but it is less used due to the modern laser techniques. Spreading of laser surgery offers some new opprotunities for its treatment. Safety of Thulium:YAG laser in transurethral vapoenucleation of the prostate in combination with its efficiency assure a good alternative for clasic open surgery in BPH treatment.Aim of the study. Comparative assessment of the efficacy of transurethral Thulium:YAG laser vapoenucleation of prostate (ThuVEP). Materials and methods. 37 patients with average age of 67 years underwent surgical treatment of large BPH at the Department of urology and surgical nephrology, State University of Medicine and Pharmacy “Nicolae Testemițanu”. Patients were divided into two treatment groups: ThuVEP (17 patients) and open simple prostatectomy (Fuller-Freyer procedure) (20 patients) and evaluated postoperatively at 3 months. Hemoglobin drop was also evaluated at the first postoperative day. Preoperative patients were investigated: PSA, IPSS, QoL, TRUS-P with PVR and Qmax. Patients inclusion criteria: Prostate Volume ≥80cm3 , IPSS ≥16 and PVR ≥ 50ml, PSA≤4ng / ml, QoL> 4, Qmax <8ml / s. Results. Average duration of intervention: 79 min vs 63 min. The prostate volume decreased postoperative on average from 82,2 cm3 to 31,3 cm3 vs 83,4 cm3 to 31,9 cm3 , there was an increase of average Qmax from 8,2 to 20.3 ml / s vs 8,4 to 21,1 ml / s, and a decrease in mean IPSS from 19,3 to 5.3 vs 20,1 to 5,4, and PVR diminished from 67.2 ml to 15,4 ml versus 68,1 to 17,4 ml, respectively. The period of transitional macrohematuria was 2,1 days vs 5,3 days respectively. The duration of cateterization was 2,3 days in the first group and 8,3 days in the second group. Mean hemoglobin drop was 2,1g/l in Group 1 vs 3,4g/l in Group 2. Conclusions. ThuVEP is an effective alternative method in the treatment of large BPH. Immediate postoperative results of ThuVEP are similar to the results in open simple prostatectomy (Fuller-Freyer procedure). It is to mention a high safety profile characteristic for ThuVEP and a reduced hemoglobin drop comparatively to clasic open surgery.