Laser enucleation is currently a viable alternative to open prostatectomy in patients with BHP over 80 cm3. However, enucleation in cases of large prostate glands is believed to potentially be a more complicated and time-consuming procedure. The aim of our study was to demonstrate that thulium fiber laser enucleation (ThuFLEP) is a highly effective treatment modality for BPH exceeding 200 cm3.
Our retrospective study included 25 patients aged 67.2 (54-89) years with infravesical obstruction (IPSS>20, Qmax<12) due to BPH. Twelve patients (Group A) underwent ThuFLEP and 13 patients (Group B) underwent open prostatectomy. Patients with urethral strictures, bladder stones, acute inflammation of the genitourinary tract or a history of prior prostate surgery were excluded. For enucleation, we used Urolase (NTO IRE-POLUS, Russia), a 120 W thulium fiber laser, and a 600 µm fiber. Tissue removal from the bladder was performed with the help of a Piranha morcellator (Richard Wolf, Germany). Preoperatively and six months after surgery we evaluated IPSS, QoL, Qmax and post-void residual volume. All statistical analyses were performed using SPSS Statistics 22.0 (SPSS Inc., Chicago, IL, USA). A p-value of 0.05 was chosen as a threshold for statistical significance.
Mean BPH volume was 214.0 cm3 (200-250 cm3) in the ThuFLEP group and 209.9 cm3 (200-240 cm3) in the open prostatectomy group. Mean surgery time was 145.5±32.6 min for ThuFLEP and 144.9±29.9 min for open prostatectomy. Mean mass of removed tissue was 179.0 g (group А) and 166.7 g (group B). Catheterization time was 27.6 hours in group A and 210.5 hours in group B. Hospital stay was 3.3 days in group A and 13.9 days in group B. Stress urinary incontinence 6 months after surgery was only observed in one (7.7%) group B patient. One group B patient (7.7%) required blood transfusion due to postoperative bleeding. Six months after surgery, we observed a statistically significant improvement in IPSS, QoL, Qmax and post-void residual volume in all the patients (p<0.05). There were no differences in the above mentioned parameters between the two groups.
Despite yielding similar results in terms of management of infravesical obstruction caused by BPH, retropubic prostatectomy is characterized by higher postoperative complication rates than ThuFLEP. Laser enucleation proved to be a faster and safer treatment option for BPH over 200 cm3. Apart from that, thulium enucleation allows for faster return to normal life and considerably shortens hospital stay.