Search

We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62-73] years vs 69 [63-74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52-92] ml in Group 1 vs 70 [54-90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 ( P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 ( P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI., (Copyright © 2024 Copyright: © The Author(s)(2024).) more...

Purpose: To compare Holmium laser with MOSES technology (MoLEP) and Thulium fiber laser enucleation of the prostate (ThuFLEP) in terms of surgical and functional outcomes., Methods: We performed a retrospective analysis of all patients who underwent either procedure in five centers (January 2020-January 2022)., Exclusion Criteria: previous urethral/prostatic surgery, radiotherapy, concomitant surgery. Propensity score matching (PSM) analysis was performed to adjust for the bias inherent to the different characteristics at baseline. Differences between procedures were estimated using Firth Penalized Likelihood regression for International prostate symptom score (IPSS), quality of life (QL), maximum flow rate (Qmax)., Results: PSM retrieved 118 patients in each group. Baseline characteristics were similar except for PSA and number of men on indwelling catheter (higher in MoLEP group). Median surgical time was significantly longer in the MoLEP group despite the enucleation and morcellation times being similar. Median catheter dwelling time and postoperative length of stay were similar. Most of the early complications were Clavien ≤ 2 grade. There were only two Clavien grade 3 complications (one for each group), one grade 4 in MoLEP group. Rate and type of early and persistent incontinence (> 3 months) were similar. At 12-month, proportion of patients reaching a decrease (Δ) of IPSS ≥ 18 from baseline was significantly larger in MoLEP group, with no significant difference in ΔQmax > 12 ml/sec and ΔQL ≥ -3., Conclusion: MoLEP and ThuFLEP were safe and efficacious procedures with similar short-term operative and functional outcomes. At 1-year, MoLEP patients had a sustained reduction of IPPS score., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) more...

Objective: The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). Materials and Methods: We analyzed patients who underwent ThuFLEP due to lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, postvoid residual (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen level, and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization, and data on hospital stays were also collected. A subgroup analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. Results: A total of 1328 patients were included in the analysis. The mean age was 66.9 ± 7.5 years. Mean prostate volume was 86.9 ± 41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery ( p  < 0.05) and showed durable improvement up to 3 years of follow-up. The frequency of late complications was as follows: stress urinary incontinence-1.2%; urethral stricture-1.1%; and bladder neck contracture-0.9%. Subgroup analyses revealed increased urinary tract infection frequency in older patients (3.5% vs 0.8%, p  = 0.003) as well as higher rate of stress urinary incontinence (0.4% vs 1.8%, p  = 0.002) and higher rate of clot retention (11.3% vs 4.4%, p  < 0.001) in those with larger glands. Conclusions: Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be a promising alternative to holmium laser enucleation of the prostate for treatment of LUTS associated with BPO. more...

Purpose: To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP)., Methods: This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10 ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months were collected., Results: Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3 months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54)., Conclusion: The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms. Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) more...

Purpose of Review: In this narrative review, we will focus on a novel thulium fiber laser's physical properties in terms of its clinical applicability., Recent Findings: TFL has successfully moved forward from the preclinical trials into clinical practice and now is being widely used in clinics around the world. The available data suggest that the device effectively operates in soft tissues - benign prostate hyperplasia (BPH) and bladder tumors, as well as in lithotripsy. Also, the first promising results were obtained from laparoscopic surgery showing its possible applicability in the management of renal cell carcinoma. The constructional changes in fiber laser's design, lead to alteration of laser-tissue interactions, which resulted in clinical advantages of the device. Yet, the exact mechanism often is considered complex for understanding. With this work, we are aiming to build a bridge between biophysics and clinical practice and give a simple explanation of how the devices is working and why the knowledge of it is important for a clinician., Summary: The more effective wavelength (closer to the water absorption peak), favorable beam profile, different modes of action allowing to decrease carbonization on one hand and retropulsion on the other, all this makes TFL an evolution in urologic surgery. Further trials investigating on the possible pros and cons of the device are awaited., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.) more...

Enucleation remains enucleation regardless of the device (same safety and efficiency in experienced hands). However, every laser brings something new (better cutting, shorter learning curve, superior hemostasis) and each surgeon should chose a laser according to their own experience, expectations, and demands., (Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.) more...

The goal of this study was to assess the ablation, coagulation, and carbonization characteristics of the holmium:YAG (Ho:YAG) laser and thulium fiber lasers (TFL). The Ho:YAG laser (100 W av.power), the quasi-continuous (QCW) TFL (120 W av.power), and the SuperPulsed (SP) TFL (50 W av.power) were compared on a non-frozen porcine kidney. To control the cutting speed (2 or 5 mm/s), an XY translation stage was used. The Ho:YAG was tested using E = 1.5 J and P av  = 40 W or P av  = 70 W settings. The TFL was tested using E = 1.5 J and P av  = 30 W or P av  = 60 W settings. After ex vivo incision, histological analysis was performed in order to estimate thermal damage. At 40 W, the Ho:YAG displayed a shallower cutting at 2 and 5 mm/s (1.1 ± 0.2 mm and 0.5 ± 0.2 mm, respectively) with virtually zero coagulation. While at 70 W, the minimal coagulation depth measured 0.1 ± 0.1 mm. The incisions demonstrated zero carbonization. Both the QCW and SP TFL did show effective cutting at all speeds (2.1 ± 0.2 mm and 1.3 ± 0.2 mm, respectively, at 30 W) with prominent coagulation (0.6 ± 0.1 mm and 0.4 ± 0.1 mm, respectively, at 70 W) and carbonization. Our study introduced the TFL as a novel efficient alternative for soft tissue surgery to the Ho:YAG laser. The SP TFL offers a Ho:YAG-like incision, while QCW TFL allows for fast, deep, and precise cutting with increased carbonization., (© 2020. Springer-Verlag London Ltd., part of Springer Nature.) more...

Purpose of Review: This review aims to highlight the pros and cons of each laser device and to consider additional possible milestones for the development of laser technologies in the surgical treatment of benign prostate hyperplasia., Recent Findings: Over the last three decades, lasers' role in endourology has gone from strength to strength. Specifically, the primary techniques where laser surgery for BPO relief is concerned are vaporization and enucleation. The idea behind vaporization is that lasers are able to vaporize substantial amounts of tissue due to deep ablation depth and increased power. The most efficient devices for vaporization are those affecting hemoglobin as primary chromophore and/or using a continuous firing mode (KTP/LBO:YAG, diode lasers, Tm:YAG). As for enucleation, multiple devices have been suggested for the adequate anatomical enucleation of the prostate (EEP). As it is a skill-dependent technique, the EEP is effective irrespective of which device the surgeon uses. However, some devices have shown significant advances where enucleation is concerned., Summary: The choice of device should be based primarily on the technique the surgeon prefers. Although the most suitable lasers for vaporization are hemoglobin-targeting and/or continuous wave devices, the EEP may be done with any enough powered laser, yet some provides specific effects which you should be aware before the surgery., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.) more...

Purpose: To evaluate the impact of the fiber-tissue distance on histological parameters in a porcine kidney model., Methods: Four lasers were tested at 60 W using a 600-µm bare-ended fiber: a continuous wave (cw) thulium fiber laser (TFL), a super pulsed (SP) TFL, a Ho:YAG laser, and a blue diode laser (BDL). All tissue samples were mounted on a motorized XY-translation stage. The fiber-tissue distance was changed within a range from 0to 6 mm. Ten incisions were made with each laser at each distance. Afterwards, the tissue samples were sliced with a microtome for lactate dehydrogenase staining to determine zones of thermal damage., Results: In contact mode, the largest incision depth was found for the cw TFL (1.7 ± 0.1 mm) compared to the SP TFL (1.0 ± 0.1 mm), BDL (0.9 ± 0.1 mm) and HoYAG laser (1.1 ± 0.1 mm), respectively. With regard to the coagulative properties, the SP TFL and the Ho:YAG laser showed comparable coagulation depths with 0.7 ± 0.1 and 0.6 ± 0.1 mm, respectively. At 2 mm fiber-tissue distance, the Ho:YAG laser was the only laser that vaporized tissue (incision depth: 0.2 ± 0.1 mm). The BDL was the only laser that caused coagulation at a distance of 3-5 mm., Conclusion: Our results support the clinical observation that cw TFL must be defocused for best coagulation, while the coagulation depth of the SP TFL remains nearly constant within the range of 0-3 mm. Increasing the distance of the laser fiber to the tissue up to 5 mm did not cause significant differences with regard to coagulation depth using the BDL. more...

"Theatre acting is the operation with ascalpel, movie acting is an operation with a laser". Michael Caine. Being the instrument in hands of urologist laser is much more than a single-application device. Its applicability is deeply dependent on physical properties, settings, and environment. With knowledge of how the device work, why it affects the tissue, and how this laser-tissue interaction goes surgeon can shape further clinical work to choose the best devices or techniques of surgery. Tailoring the laser effects on the needs of the patient. In this paper, we tried to briefly describe what a laser device consists of, the most important laser-tissue interactions that are necessary for understanding the operation of the laser, and the main laser systems that are used in urology. more...

Objective: To analyze the long-term efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia. Materials and Methods: A total of 127 patients who underwent HoLEP at our institution between 2013 and 2015 were included. Patients were observed for 5 years postoperatively. We evaluated the length of the surgery, the mass of the removed tissue, prostate-specific antigen level, the maximal flow rate (Qmax), postvoid residual (PVR), the length of catheterization and hospitalization, and the International Prostate Symptom Score (IPSS) and IPSS quality of life (QoL) at each clinic visit. Results: PVR, Qmax, IPSS, and QoL all improved significantly immediately after the operation ( p  < 0.001). By the end of the 5th postoperative year, all the parameters showed a statistically meaningful decline: Qmax reduced by 5.8 mL/s (22.6%) and IPSS by 1.4 points (29.1%). Around 8.6% of the patients continued therapy with α-blockers. There were no differences in efficacy by the age of the patients or the volume of the prostate. Long-term complications and need for repeat operations were not affected by the volume of the prostate or patient age. Conclusions: The improvement of PVR, Qmax, IPSS, and QoL score seen in the early postoperative period after performing HoLEP remains evident at 5 years postoperatively. Long-term complications and the need for reoperation do not depend on the age of the patient or on the initial volume of the prostate. more...

Aim: To test the characteristics of a hybrid laser (combination of a thulium and blue diode laser) vs thulium and Ho:YAG lasers regarding soft tissue ablation. Methods: Tissue samples of fresh nonfrozen porcine kidneys were used to compare the three lasers. A motorized translation XY stage with a fixed fiber holder to control the speed of cutting (2 and 5 mm/s) was used. Five incisions with each laser were performed. Lactate dehydrogenase staining of the embedded specimens was performed to determine incision depth, zones of vaporization, coagulation zone, carbonization grade, and thermomechanical damage of the coagulated tissue. All data are expressed as mean ± standard deviation. Results: The hybrid laser demonstrated the highest vaporization speed (34.4 ± 0.1 mm 3 /s) and coagulation zones (10 ± 0.1 mm 2 ) at a drag speed of 5 mm/s among the investigated lasers. It showed a two to three times larger coagulation zone compared with the Ho:YAG laser (4 ± 0.1 mm 2 ). The continuous wave thulium fiber laser (cwTFL) showed a significantly higher grade of carbonized tissue compared with the hybrid and Ho:YAG lasers. Conclusions: The hybrid laser showed deeper incisions and a faster vaporization speed compared with the cwTFL and the Ho:YAG laser. It might be an effective tool to combine the advantages of both lasers to effectively vaporize soft tissue with excellent coagulative properties. more...

Purpose: To evaluate the ablation capacity using two Thulium fiber lasers (TFL) in a porcine kidney model., Methods: All tissue samples were mounted on a motorized stage for a precise speed of cutting. A continuous wave (cw) TFL and a super pulsed (SP) TFL were used at power settings of 60 and 120 W with 200 and 600 µm laser fibers. After lactate dehydrogenase staining, histological evaluation was performed to measure the vaporization volume (VV), ablation depth (AD), thermo-mechanical damage zones (TMZ), coagulation zones (CZ) and the carbonization grade (CG)., Results: At 120 W, no significant differences were seen between 200 and 600 µm fibers utilizing the cw TFL regarding VV (24.6 vs. 28.2 mm 3 /s), AD (5.6 vs. 5.7 mm), TMZ (0 vs. 0 mm 2 ) and CZ (18.1 vs. 12.3 mm 2 ). Using the SP TFL, no significant differences between both fiber diameters with regard to VV (4 vs. 6.2 mm 3 /s), AD (2.7 vs. 3.4 mm), TMZ (1 vs. 2.6 mm 2 ) and CZ (3.1 vs. 2.2 mm 2 ) at 120 W were found, respectively. However, the VV of the cw TFL at 60 W was significantly less compared to 120 W using 200 and 600 µm fibers, respectively, whereas the SP TFL did not show significant differences between 60 and 120 W with regard to VV. SP TFL showed a consistently lower CG compared to cw TFL., Conclusions: This experiment suggests that there is no significant difference using 200 or 600 µm laser fibers in cw or SP TFLs. However, the cw TFL produces a coagulation zone three to five times larger than the SP TFL regardless of the fiber diameter. more...

Introduction: Endoscopic enucleation of the prostate (EEP) is a safe method of treating benign prostatic hyperplasia, regardless of prostate volume and type of applied energy. To date, however, there has been no study that examines complication rates with respect to the type of applied energy. This study aims to address this problem by providing a retrospective analysis of >1400 patients who have undergone prostate enucleation. Materials and Methods: We performed a retrospective analysis of all patients undergoing EEP between 2013 and 2018 at a single tertiary institution. This analysis included patients who had undergone one of three forms of EEP: holmium laser enucleation of the prostate (HoLEP), thulium fiber laser enucleation of the prostate (ThuFLEP), or monopolar enucleation of the prostate (MEP). We compared intraoperative and early postoperative complications, as well as complications at 3 and 6 months follow-up. Results: A total of 1413 patients were included in this study; 36% patients underwent HoLEP, 57.5% had ThuFLEP, and 6.5% MEP. The most frequent complication in the early postoperative period was a mild fever (2.76% of the cases). The morcellation was delayed to a separate stage because of intensive hemorrhaging in 1.4% of the cases. Bladder tamponade was found in 1.1% of the cases. We found no correlation between complication rate and either prostate volume or energy source. Stress urinary incontinence was found in 3.9% of patients at 3 months and in only 1.4% of patients at 6 months after the operation. Urethral stricture at 6 months after the surgery was found in 1.4% of patients, whereas bladder neck sclerosis was found in only 0.9% of these cases. No significant difference was observed between these complication frequencies and any preoperative factors or energy source. Conclusions: All EEP types are safe with equal rates of complications intraoperatively, postoperatively, and at 6 months follow-up. more...

Purpose of Review: To summarize recent publications on the topic of laser in urology and explore new developments which may impact the future role of lasers in surgery., Recent Findings: Ho: Yttrium-aluminium garnet (YAG) laser with Moses technology allows less retropulsion during a lithotripsy, yet its efficacy needs to be tested in clinical trials. Data on the efficacy of this device for benign prostatic obstruction treatment is also pending. A new promising generation of laser systems - thulium-fiber (Tm-fiber) lasers - has been introduced. Tm-fiber has already been shown to be effective and well tolerated in endoscopic enucleation of the prostate and has demonstrated favorable outcome compared with Ho:YAG in preclinical lithotripsy studies. However, more studies are needed to better understand the use of this novel technology and elucidate its role within the armamentarium of available technologies., Summary: Lasers remain an integral part of benign prostatic hyperplasia surgery and stone treatment and gain popularity in en-bloc resection of bladder cancer. Current efficacy of laser systems in prostate cancer ablation and their place in laparoscopy remain unclear, despite promising initial reports. more...

Objective: To compare the efficacy and safety of a novel thulium fiber laser for endoscopic enucleation of the prostate with monopolar transurethral resection of the prostate in patients with smaller glands (<80 cc)., Methods: A total of 51 patients underwent thulium fiber laser enucleation of the prostate, and 52 patients underwent monopolar transurethral resection of the prostate. All patients were assessed preoperatively, and at 3, 6, and 12 months postoperatively (International Prostate Symptom Score, maximum urine flow rate, International Prostate Symptom Score-quality of life). Preoperative prostate volumes and prostate-specific antigen levels were comparable (P = 0.543 and P = 0.078, respectively). The complications were graded according to the Clavien classification., Results: Mean surgery time was longer in the thulium fiber laser enucleation of the prostate group (46.6 ± 10.2 vs 39.9 ± 8.6 min, P < 0.001), while catheterization and hospital stay were greater in the transurethral resection of the prostate group (P < 0.001). At 12 months, there were no differences in functional outcomes (International Prostate Symptom Score, maximum urine flow rate). Despite comparable prostate volumes at 12 months (P = 0.864), the prostate-specific antigen level in the thulium fiber laser enucleation of the prostate group (0.5 ± 0.5 ng/mL) was lower than in the transurethral resection of the prostate group (1.1 ± 1.0 ng/mL; P < 0.001). Hemoglobin and serum sodium decrease was lower in the thulium fiber laser enucleation of the prostate group (1.01 ± 0.4 g/dL and 1.1 ± 1.1 mmol/L) than in the transurethral resection of the prostate group (1.8 ± 0.8 g/dL and 4.1 ± 1.1 mmol/L; P < 0.001). Urinary incontinence rates at 12 months were comparable (P = 0.316)., Conclusions: Thulium fiber laser enucleation of the prostate with novel thulium fiber laser in patients with smaller prostate glands (<80 cc) is comparable to transurethral resection of the prostate in voiding parameters improvement and complication rates. At the same time, the technique allows for a more substantial prostate-specific antigen decrease, indicating more complete removal of adenoma., (© 2019 The Japanese Urological Association.) more...

Introduction: The objective of this study was to assess the efficacy and safety of novel thulium fiber laser enucleation of the prostate (ThuFLEP) vs conventional open simple retropubic prostatectomy (OP) for large volume benign prostatic hyperplasia (BPH)., Methods: We performed a retrospective review of patients who underwent surgical treatment for large volume BPH (>80 cc) from 2015 to 2017. Preoperative patient examination included the assessment of functional parameters: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Q max ), and postvoid residual urine volume. The hemoglobin level was measured before and after the operation., Results: A total of 130 patients were included in the study. Of these, 40 patients underwent OP, and 90 patients underwent ThuFLEP. Groups were similar in terms of preoperative functional parameters (IPSS, QoL, and Q max ). The mean operative time was comparable for both procedures (p = 0.285) as well as the mass of adenomatous tissue resected (p = 0.412). Resection speed was comparable (OP-0.9 vs ThuFLEP-1.0 g/min, p = 0.52). Patients in OP had significantly longer catheterization time and length of hospital stay (9.0 days vs 3.3 days, p < 0.001). At 6 months, stress urinary incontinence rate were 1.1% after ThuFLEP and 2.5% after OP., Conclusions: Despite the equally high efficacy of both modalities for infravesical obstruction due to BPH, ThuFLEP is a minimally invasive modality that is associated with a shorter hospital stay, a significantly greater return to normal activities, and a considerable reduction in rehabilitation time. Our results demonstrated that the ThuFLEP is a highly efficacious, minimally invasive modality for the management of BPH in large volume glands (>80 cc). more...

Introduction: Endoscopic enucleation of the prostate (EEP) has been recognized as a viable treatment modality for men with benign prostatic hyperplasia (BPH). The aim of our study was to compare the efficacy and functional outcomes of three different techniques of EEP, including monopolar enucleation (MEP), holmium laser enucleation of the prostate (HoLEP), and thulium laser enucleation of the prostate (ThuLEP)., Methods: The study consisted of a retrospective comparison of pre- and postoperative parameters in men undergoing three types of EEP: MEP, HoLEP, and ThuLEP. Functional parameters were evaluated before and 6 months after surgery, which included the International Prostate Symptom Score, maximum flow rate, postvoid residual volume, prostate volume, and sodium levels of all patients., Results: A total of 551 men with the mean age of 67.1 years were included in the study. Of these, MEP was performed on 95 patients, HoLEP was performed on 254 patients, and ThuLEP on 202 patients. The mean mass of morcellated tissue obtained during the three techniques did not differ significantly (p > 0.05). Mean procedure times of ThuLEP and HoLEP were shorter than MEP demonstrating 72, 76, and 86 minutes, respectively (p < 0.01). The mean catheterization time following laser EEPs was shorter than MEP as shown by 1.3, 1.3, and 3.8 days, respectively (p < 0.01). Hospital stay times of HoLEP and ThuLEP were shorter than MEP demonstrated by 3.3, 3.4, and 6.9 days, respectively (p < 0.01). Patients after MEP had significant decrease in postoperative hemoglobin and sodium levels. All the groups showed statistically significant improvement in the aforementioned parameters following treatment., Conclusions: Both techniques of laser enucleation proved to be efficacious in the management of BPH. MEP of the prostate seems to be a highly promising addition to the list of enucleation techniques and was determined to be an effective and acceptable procedure, despite a higher complication rate. more...

Background: Transurethral resection of the prostate (TURP) is considered to be the standard treatment for patients with benign prostatic obstruction (BPO) ≤80 mL. However, up to 14.7% of the patients require secondary TURP due to recurrent BPO. The aim of our study was to describe specific features of holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) in patients with recurrent BPO after previous prostate surgery., Materials and Methods: A total of 768 consecutive patients from our prospective collected database were retrospectively reviewed and divided into 4 groups: group A (489 patients) and group C (253 patients) underwent primary HoLEP and ThuLEP treatment, while group B (17 patients) and D (9 patients) included patients with recurrent BPO who were treated with HoLEP and ThuLEP, respectively., Results: There were no significant differences in preoperative parameters between the groups at primary (A and C) and secondary (B and D) treatment except their age. At 6-month follow-up, voiding parameters and symptom scores showed statistically significant improvements compared to baseline without differences between the groups. The mean operative time was comparable between the groups and did not differ significantly (p > 0.05)., Conclusions: Laser enucleation for the treatment of recurrent BPO is feasible and seems to be a safe and effective procedure., (© 2018 S. Karger AG, Basel.) more...