Thulium laser vaporesection (ThuVaRP) versus bipolar transurethral resection of the prostate (TURP) in benign prostate hyperplasia in term of safety and efficacy: A two-year-follow-up study in Erbil, Iraq

Wishyar Jamal Al-Bazzaz; Nihad Rifaat Jawad; Ali W. AlKhayat

doi:10.15218/zjms.2020.027

Authors

Wishyar Jamal Al-Bazzaz Department of Urology, Rizgary Teaching Hospital, Erbil, Iraq.
Nihad Rifaat Jawad Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
Ali W. AlKhayat Erbil Teaching Hospital, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2020.027

Keywords:

Benign prostatic hyperplasia, Transurethral resection of the prostate, Thulium laser

Abstract

Background and objective: Prostate Thulium laser vaporization is a novel treatment option for a bladder outlet obstruction caused by benign prostate enlargement. However, this surgical technique has not yet been standardized. We present our finding of using Tm vaporesection of the prostate. This study aimed to assess the efficacy and safety of thulium laser versus bipolar transurethral resection of the prostate for treating patients with benign prostatic obstruction.

Methods: Sixty three consecutive patients with benign prostatic hyperplasia attending public and private clinics in Erbil city were included in a comparative study from June 2014 to July 2016. Thulium laser vaporesection of the prostate was done for Group I (n = 31), and transurethral resection of the prostate was done for Group II (n = 32). All cases were evaluated preoperatively and were evaluated at 6-24 months postoperatively by international prostate symptom score, post void residual urine volume, and quality of life. Forty four patients completed the two years of follow up.

Results: Thulium laser vaporization was significantly superior to bipolar plasmakinetic resection of the prostate in term of catheterization time (1.2 ± 0.7 vs 4.9 ± 1.7 days, P ≤0.001), hospital stay (1.5 ± 0.9 days vs 3.2 ± 1.6 days, P = 0.001) and drop in hemoglobin (0.8 ± 0.3 vs 2.35 ± 0.4 g/dl, P ≤0.001) and inferior to PKRP operation time (68.2 ± 27.3 vs 58.3 ± 22.7, P = 0.122). Both groups resulted in a significant improvement from baseline in terms of subjective symptoms scoring, but no significant difference was found between the two groups.

Conclusion: Thulium laser vaporesection of the prostate is a safe and effective procedure for the treatment of symptomatic benign prostatic obstruction, with low perioperative morbidity however, both procedures showed no significant difference in terms of international prostate symptom score, post void residual urine volume and quality of life.

Metrics

Metrics Loading ...

References

Oelke M, Bachmann A, Descazeaud A, Emberton M, Graves S, Michel MC, et al. EAU Guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Euro Urol 2013; 64:118–40.

Zhuo J, Wei HB, Zhao FJ, Sun F, Han BM, Sun XW, et al. Two-micrometer thulium laser resection of the prostate-tangerine technique for patients with acute urinary retention. Lasers Med Sci 2014; 29(3):1093–98.

Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol 2004; 46:547–54.

Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al.Urology section of the Bavarian Working Groub for Quality Assurance. Morbidity, mortality and early outcome of transurethral resection of the prostate: a postoperative multicenter evaluation of 10,654 patients. J Urol 2008; 180:246–9.

Al-Ansari A, Younes N, Sampige VP, Al-Rumaihi K, Ghafouri A, Gul T, et al. Green light laser vaporization versus transurethral resection of HPS 120-W the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. Eur Urol 2010; 58(3):349–55.

Barboza LE, Malafaia O, Slongo LE, Meyer F, Nassif PA, Tabushi FI. Holmium laser enucleation of the prostate. (HoLEP) versus transurethral resection of the prostate. (TURP). Rev Col Bras Cir 2015; 42:165–70.

Dusing MW, Krambeck AE, Terry C, Matlaga BR, Miller NL, Humphreys MR. Holmium laser enucleation of the prostate: efficiency gained by experience and operative technique. J Urol 2010; 184:635–40.

Fried NM, Murray KE. High-power thulium fiber laser ablation of urinary tissues at 1.94 um. J Endourol 2005; 19:25–31.

Fried NM. High-power laser vaporization of the canine prostate using a 110 W thulium fiber laser at 1.91 pm. Lasers Surg Med 2005; 36:52–6.

Xia SJ, Zhang YN, Lu J, Sun XW, Zhang J, Zhu YY, et al. Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia in Chinese. Zhonghua Yi Xue Za Zhi 2005; 85:3225–8.

Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN. Thulium laser versus standard transurethral resection of the prostate: A Randomized Prospective trial. Eur Urol 2008; 53(2):382–9.

Bach T, Xia SJ, Yang Y, Mattioli S, Watson GM, Gross AJ, et al. Thulium: YAG 2 Im cw laser prostatectomy: where do we stand? World J Urol 2010; 28(2):163–8.

Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic 13 review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 2015; 67:1066–96.

Reich O. Bipolar transurethral resection of the prostate: what did we learn, and where do we go from here? Eur Urol 2009; 56(5):796–7.

Huang X, Wang XH, Wang HP, Qu LJ. Comparison of the microvessel diameter of hyperplastic prostate and the coagulation depth achieved with mono- and bipolar transurethral resection of the prostate. A pilot study on hemostatic capability. Scand J Urol Nephrol 2008; 42:265–8.

Hu Y, Dong X, Wang G, Huang J, Liu M, Peng B. Five-year follow-up study of transurethral plasmakinetic resection of the prostate for benign prostatic hyperplasia. J Endourol 2016; 30:97–101.