Feasibility, safety and efficacy of using low-power thulium: YAG laser enucleation of prostate compared to HoLEP in developing country.

Abstract

Introduction: We aimed to assess and compare the feasibility and perioperative outcomes using low-power thulium laser enucleation of the prostate (ThuLEP) compared to standard holmium laser enucleation of the prostate (HoLEP) in the management of BPO-related symptoms due to prostates volume exceeding 80 ml.

Material and methods: One hundred and fifty patients with large prostates indicated for prostate enucleation were prospectively randomized into two groups: HoLEP group (74 patients), and the low-power ThuLEP group (76 patients). Preoperative assessment included digital rectal examination, serum prostate-specific antigen, transrectal ultrasonography, uroflowmetry, postvoid residual urine (PVR) measurement, and International Prostate Symptom Score (IPSS) and QoL scoring systems.

Results: The mean age for the HoLEP group was 68 ±5.0 years and 69 ±4.8 years for the low-power ThuLEP group. The mean prostate volume was 87 ±11.5 cc for HoLEP and 90 ±12.0 cc for ThuLEP, with no statistically significant differences between both groups (p = 0.1079). There was a statistically significant difference between both groups with regard the mean total operative time, which was 72 ±10.5 minutes for HoLEP and 92 ±11.5 minutes for ThuLEP, and the mean enucleation time, which was 50 ±8.5 minutes for HoLEP and 70 ±7.0 minutes for ThuLEP (p <0.001). No significant differences between the groups regarding catheterization time, hospital stay, or haemoglobin drop. Subjective and objective voiding parameters as IPSS and Qol scores, Q_max, and PVR improved significantly after treatment with both techniques with no statistically significant difference between both groups. The complication rate was low.

Conclusions: Although HoLEP offers shorter operative time, low-power ThuLEP is a feasible choice for surgical management of benign prostatic obstruction as it offers similar clinical outcomes.