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Safety and efficiency of thulium laser prostate resection for the treatment of benign prostatic hyperplasia in large prostates

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Abstract

Thulium laser resection of the prostate-tangerine technique (TmLRP-TT) dissects whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. The present study aimed to evaluate the safety and efficacy of TmLRP-TT for older symptomatic benign prostatic hyperplasia patients with large prostates during 18 months of follow-up. A prospective analysis of 95 consecutive patients with large prostates (>80 ml) who underwent surgical treatment using TmLRP-TT was carried out. All patients were evaluated preoperatively and at 1, 6, 12, and 18 months postoperatively by the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Q max), postvoid residual urine volume (PVR), International Index of Erectile Function 5 (IIEF-5), urine analysis, and urine culture. Perioperative complications were recorded and graded by the modified Clavien classification system (CCS). Mean preoperative prostate volume was 106.81 ± 24.79 ml. TmLRP-TT was successfully completed in all patients. The mean operative duration, catheterization time, and hospital stay were 95.36 ± 27.06 min, 2.25 ± 0.9 days, and 5.39 ± 1.18 days, respectively. The decrease in mean hemoglobin level was 1.23 ± 0.72 g/dl, and that in mean serum sodium level was 0.71 ± 2.56 mmol/l. Within the observation period of 18 months, the patients showed an improvement in IPSS (20.01 ± 7.08 vs. 4.96 ± 3.68), QoL (4.10 ± 1.16 vs. 1.23 ± 1.30), Q max (8.14 ± 3.81 ml/s vs. 18.33 ± 2.56 ml/s) and PVR (102.70 ± 70.64 ml vs. 20.28 ± 30.02 ml), compared with baseline values (P < 0.001). IIEF-5 remained stable. Minor complications occurred in 10 (10.52 %) of 95 patients (Clavien grade 1, 9.47 % and grade 2, 1.05 %). There were no severe complications requiring reintervention (Clavien grade 3, 0 % and grade 4, 0 %). TmLRP-TT is a safe and effective surgical endoscopic technique associated with a low complication rate in large prostates as assessed during an 18-month follow-up period. It is a promising technology, which may be considered as one of the alternatives to open simple prostatectomy (OP) for large prostates in the future.

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References

  1. Patel A, Adshead JM (2004) First clinical experience with new transurethral bipolar prostate electrosurgery resection system: controlled tissue ablation (coblation technology). J Endourol 18:959–964

    Article  PubMed  Google Scholar 

  2. Berry SJ, Coffey DS, Walsh PC et al (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479

    CAS  PubMed  Google Scholar 

  3. Alivizatos G, Skolarikos A, Chalikopoulos D et al (2008) Transurethral photoselective vaporization versus transvesical open enucleation for prostatic adenomas >80 ml: 12-mo results of a randomized prospective study. Eur Urol 54:427–437

    Article  PubMed  Google Scholar 

  4. Gratzke C, Schlenker B, Seitz M et al (2007) Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol 177:1419–1422

    Article  PubMed  Google Scholar 

  5. Tubaro A, Nunzio C (2006) The current role of open surgery in BPH. Eau-ebu Update Series 4:191–201

    Article  Google Scholar 

  6. Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–40. doi:10.1016/j.eururo.2013.03004

    Article  PubMed  Google Scholar 

  7. Zhu L, Chen S, Yang S et al (2013) Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70 ml: a prospective, randomized trial with 5-year followup. J Urol 189:1427–1431

    Article  PubMed  Google Scholar 

  8. Zhu G, Xie C, Wang X et al (2012) Bipolar plasmakinetic transurethral resection of prostate in 132 consecutive patients with large gland: three-year follow-up results. Urology 79:397–402

    Article  PubMed  Google Scholar 

  9. Gilling PJ, Wilson LC, King CJ et al (2012) Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 109:408–411

    Article  PubMed  Google Scholar 

  10. Zorn KC, Liberman D (2011) GreenLight 180 W XPS photovaporization of the prostate: how I do it. Can J Urol 18:5918–5926

    PubMed  Google Scholar 

  11. Liu CL, Xue DW, Liu YL et al (2011) Greenlight photoselective vaporization prostatectomy versus thulium laser vaporesection of the prostate for aged high-risk BPH patients with the prostate heavier than 80 g. Zhonghua Nan Ke Xue 17:431–434

    PubMed  Google Scholar 

  12. Bhansali M, Patankar S, Dobhada S et al (2009) Management of large (>60 g) prostate gland: PlasmaKinetic Superpulse (bipolar) versus conventional (monopolar) transurethral resection of the prostate. J Endourol 23:141–145

    Article  PubMed  Google Scholar 

  13. Finley DS, Beck S, Szabo RJ (2007) Bipolar saline TURP for large prostate glands. Sci World J 7:1558–1562

    Article  Google Scholar 

  14. Xia SJ, Zhang YN, Lu J et al (2005) Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia. Zhonghua Yi Xue Za Zhi 85:3225–8

    PubMed  Google Scholar 

  15. Xia SJ, Zhuo J, Sun XW et al (2008) Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol 53:382–389

    Article  PubMed  Google Scholar 

  16. Xia SJ (2009) Two-micron (thulium) laser resection of the prostate-tangerine technique: a new method for BPH treatment. Asian J Androl 11:277–281

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  18. Mamoulakis C, Efthimiou I, Kazoulis S et al (2011) The modified Clavien classification system: a standardised platform for reporting complications in transurethral resection of the prostate. World J Urol 29:205–210

    Article  PubMed Central  PubMed  Google Scholar 

  19. Bach T, Huck N, Wezel F et al (2010) 70 vs 120 W thulium: yttrium-aluminium-garnet 2 microm continuous-wave laser for the treatment of benign prostatic hyperplasia: a systematic ex-vivo evaluation. BJU Int 106(3):368–372

    Article  PubMed  Google Scholar 

  20. Serretta V, Morgia G, Curto G et al (2002) Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology 60:623–627

    Article  PubMed  Google Scholar 

  21. Adam C, Hofstetter A, Deubner J et al (2004) Retropubic transvesical prostatectomy for significant prostatic enlargement must remain a standard part of urology training. Scand J Urol Nephrol 38:472–476

    Article  PubMed  Google Scholar 

  22. Naspro R, Suardi N, Salonia A et al (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol 50:563–568

    Article  PubMed  Google Scholar 

  23. Condie JD, Cutherell JL, Mian A (1999) Suprapubic prostatectomy for benign prostatic hyperplasia in rural Asia: 200 consecutive cases. Urology 54:1012–1016

    Article  PubMed  Google Scholar 

  24. Varkarakis I, Kyriakakis Z, Delis A et al (2004) Long-term results of open transvesical prostatectomy from a contemporary series of patients. Urology 64:306–310

    Article  PubMed  Google Scholar 

  25. Lepor H (2004) Pathophysiology, epidemiology, and natural history of benign prostatic hyperplasia. Rev Urol 6(Suppl 9):3–10

    Google Scholar 

  26. Seki N, Monchida O, Kinukawa N et al (2003) Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases. J Urol 170:1847–1850

    Article  PubMed  Google Scholar 

  27. Elzayat EA, Elhilali MM (2007) Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol 52:1465–1471

    Article  PubMed  Google Scholar 

  28. Bach T, Herrmann TR, Ganzer R et al (2007) RevoLix vaporesection of the prostate: initial results of 54 patients with a 1-year follow-up. World J Urol 25:257–262

    Article  PubMed  Google Scholar 

  29. Netsch C, Bach T, Herrmann TR et al (2012) Thulium:YAG VapoEnucleation of the prostate in large glands: a prospective comparison using 70- and 120-W 2-microm lasers. Asian J Androl 14:325–329

    Article  PubMed Central  PubMed  Google Scholar 

  30. Bach T, Netsch C, Pohlmann L et al (2011) Thulium:YAG vapoenucleation in large volume prostates. J Urol 186:2323–2327

    Article  PubMed  Google Scholar 

  31. Mamoulakis C, Skolarikos A, Schulze M et al (2012) Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate. BJU Int 109:240–248

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Shanghai First People’s Hospital Affiliated to Shanghai Jiaotong University, No.100, Haining Road, Hongkou District, Shanghai, 200080, China

    Hai-bin Wei, Jian Zhuo, Xiao-wen Sun, Yi Shao, Sheng-jie Liang, Di Cui, Fu-jun Zhao, Jun-jie Yu & Shu-jie Xia

  2. Department of Urology, Xuzhou Central Hospital, No.199 Jiefangnan Road, Xuzhou, 221009, China

    Kun Pang

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  1. Hai-bin Wei
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  2. Jian Zhuo
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  4. Kun Pang
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Correspondence to Xiao-wen Sun.

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Hai-bin Wei and Jian Zhuo contributed equally to this work.

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Wei, Hb., Zhuo, J., Sun, Xw. et al. Safety and efficiency of thulium laser prostate resection for the treatment of benign prostatic hyperplasia in large prostates. Lasers Med Sci 29, 957–963 (2014). https://doi.org/10.1007/s10103-013-1437-8

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  • DOI: https://doi.org/10.1007/s10103-013-1437-8

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