1. Thulium laser enucleation of the prostate (ThuLEP): Results, complications, and risk factors in 139 consecutive cases
- Author
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Augusto Vercesi, Nashaat A. Hendawi, Marco Raber, Ismail M. Hassan, Lorenzo Tessa, Vincenzo Inneo, Giuseppe Di Paola, and Noor Buchholz
- Subjects
medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Urinary system ,030232 urology & nephrology ,Qmax, maximum urinary flow rate ,03 medical and health sciences ,0302 clinical medicine ,medicine ,HoLEP, holmium laser enucleation of the prostate ,Prostate enlargement ,Thulium laser ,Benign Prostatic Hyperplasia ,Transurethral resection of the prostate ,DVT, deep vein thrombosis ,business.industry ,Urinary retention ,Endoscopy ,Perioperative ,PVR, post-void residual urine volume ,medicine.disease ,QoL, quality of life ,Diseases of the genitourinary system. Urology ,Treatment ,Neck of urinary bladder ,Hb, haemoglobin ,030220 oncology & carcinogenesis ,International Prostate Symptom Score ,Prostate surgery ,RC870-923 ,Bladder stones ,medicine.symptom ,business ,ThuLEP, thulium laser enucleation of the prostate - Abstract
Objectives: To report our experience with the emerging technique of thulium laser enucleation of the prostate (ThuLEP) for the treatment for prostate hyperplasia. Patients and methods: Our inclusion criteria were an International Prostate Symptom Score (IPSS) of >15 and a quality-of-life (QoL) score of >3 in patients with confirmed bladder outflow obstruction, no longer responsive to medical therapy, with a significant post-void residual urine volume (PVR; >100 mL), with or without recurrent urinary tract infection and/or acute urinary retention. Patients with neurogenic bladder, urethral strictures, bladder stones, and previously failed transurethral prostate surgery were excluded. Results: In all, 139 men were included in the study. The mean age was 67.8 years. The IPSS and QoL score improved by 17.6 and 2.6, respectively. The flow rate increased from a mean of 9.6 mL to 31.2 mL and the PVR decreased from a mean of 131 mL to 30 mL. On univariate and multivariate analyses, operating time was a predictive factor for haemoglobin drop during the operation. Heparin prophylaxis was the only risk factor identified for postoperative bleeding. Two patients (0.01%) required blood transfusion. One patient (0.007%) required re-intervention for bleeding control, and two patients developed urethral and bladder neck strictures (0.01%). Conclusion: ThuLEP is safe and reproducible. Whilst it significantly reduces intraoperative bleeding as compared to transurethral resection of the prostate, operating time and perioperative heparin prophylaxis may still lead to a Hb drop and constitute a risk factor for postoperative bleeding. Therefore, a potential risk of deep vein thrombosis requiring heparin prophylaxis should be carefully considered and balanced with the expected clinical benefit of the operation. Keywords: Prostate enlargement, Thulium laser, Endoscopy, Treatment
- Published
- 2018