Thulium laser enucleation of prostate versus laparoscopic trans-vesical simple prostatectomy in the treatment of large benign prostatic hyperplasia: head-to-head comparison

Bertolo, Riccardo; Dalpiaz, Orietta; Bozzini, Giorgio; Cipriani, Chiara; Vittori, Matteo; Alber, Thomas; Maiorino, Francesco; Carilli, Marco; Zeder, Robin; Iacovelli, Valerio; Antonucci, Michele; Sandri, Marco; Bove, Pierluigi

doi:10.1590/S1677-5538.IBJU.2021.0726

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Original Article • IBJUInt. braz j urol 48 (2) • Mar-Apr 2022 • https://doi.org/10.1590/S1677-5538.IBJU.2021.0726 copy

Thulium laser enucleation of prostate versus laparoscopic trans-vesical simple prostatectomy in the treatment of large benign prostatic hyperplasia: head-to-head comparison

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

To compare thulium laser enucleation of prostate (ThuLEP) versus laparoscopic trans-vesical simple prostatectomy (LSP) in the treatment of benign prostatic hyperplasia (BPH).

Materials and Methods:

Data of patients who underwent surgery for “large” BPH (>80mL) at three Institutions were collected and analyzed. Two institutions performed ThuLEP only; the third institution performed LSP only. Preoperative (indwelling catheter status, prostate volume (PVol), hemoglobin (Hb), Q_max, post-voiding residual volume (PVR), IPSS, QoL, IIEF-5) and perioperative data (operative time, enucleated adenoma, catheterization time, length of stay, Hb-drop, complications) were compared. Functional (Q_max, PVR, %ΔQ_max) and patient-reported outcomes (IPSS, QoL, IIEF-5, %ΔIPSS, %ΔQoL) were compared at last follow-up.

Results:

80 and 115 patients underwent LSP and ThuLEP, respectively. At baseline, median PVol was 130 versus 120mL, p <0.001; Q_max 9.6 vs. 7.1mL/s, p=0.005; IPSS 21 versus 25, p <0.001. Groups were comparable in terms of intraoperative complications (1 during LSP vs. 3 during ThuLEP) and transfusions (1 per group). Differences in terms of operative time (156 vs. 92 minutes, p <0.001), Hb-drop (-2.5 vs. −0.9g/dL, p <0.001), catheterization time (5 vs. 2 days, p <0.001) and postoperative complications (13.8% vs. 0, p <0.001) favored ThuLEP. At median follow-up of 40 months after LSP versus 30 after ThuLEP (p <0.001), Q_max improved by 226% vs. 205% (p=0.5), IPSS decreased by 88% versus 85% (p=0.9), QoL decreased by 80% with IIEF-5 remaining almost unmodified for both the approaches.

Conclusions:

Our analysis showed that LSP and ThuLEP are comparable in relieving from BPO and improving the patient-reported outcomes. Invasiveness of LSP is more significant.

Keywords:
Prostatectomy; Thulium; Prostatic Hyperplasia

		Group LSP n = 80	Group ThuLEP n = 115	p-value
Age, years		69 (65 – 74)	68 (64 – 73)	0.5
Charlson's Comorbidity Index				0.7
	0-1	80 (100)	112 (97.4)
	≥ 2	0 (0)	3 (2.6)
BMI		27.0 (24.4 – 28.7)	25.0 (23.3 – 27.0)	< 0.001
Indwelling catheter		35 (43.8)	16 (13.9)	< 0.001
PSA, ng/mL		11.0 (4.9 – 15.8)	3.1 (2.3 – 5.6)	< 0.001
Hemoglobin, g/dL		14.9 (14.2 – 15.8)	14.2 (13.4 – 15.6)	0.003
Prostate Volume, mL		130 (115 – 150)	120 (100 – 160)	< 0.001
Qmax, mL/s		9.6 (5.9 – 11.3)	7.1 (5.9 – 8.7)	0.005
PVR, mL		100 (50 – 200)	90 (75 – 120)	0.09
IPSS		21 (16 – 27)	25 (23 – 27)	< 0.001
QoL		5 (4 – 5)	6 (5 – 6)	< 0.001
IIEF-5		15 (6 – 22)	19 (16 – 23)	< 0.001

		Group LSP n = 80	Group ThuLEP n = 115	p-value
Operative time, min		156 (134 – 193)	92 (70 – 110)	< 0.001
Intraoperative Complications		1 (1.3)	3 (2.6)	0.6
Resected Adenoma, grams		83 (70 – 104)	85 (67 – 118)	0.7
Hemoglobin at 1^st postoperative day, g/dL		12.5 (11.5 – 13.2)	13.1 (12.5 – 14.2)	< 0.001
Δ Hemoglobin at 1^st postoperative day, g/dL		-2.5 (-3.0 – −1.8)	-0.9 (-1.7 – −0.3)	< 0.001
% Δ Hemoglobin at 1^st postoperative day		-16.6 (-21.1 – −12.3)	-6.0 (-11.5 – −2.3)	< 0.001
Postoperative Complications^* * According to Clavien-Dindo Classification.		11 (13.8)	0 (0)	< 0.001
	1	6 (7.5)	-
	2	3 (3.7)	-
	3b	1 (1.3)	-
	4a	1 (1.3)	-
Transfusions		1 (1.3)	1 (0.9)	0.8
Catheterization Time, days		5 (5-7)	2 (1-3)	< 0.001
Hospital Stay, days		9 (8-9)	2 (2-3)	< 0.001
PSA at 3^rd Postoperative Month, ng/mL		1.0 (0.4 – 2.1)	1.8 (1.2 – 2.5)	< 0.001
Δ PSA at 3^rd Postoperative Month, ng/mL		-9.1 (-14.0 – −4.0)	-1.4 (-3.5 – −0.6)	< 0.001
% Δ PSA at 3^rd Postoperative Month		-90 (-96 – −78)	-46 (-70 – −26)	< 0.001
Q_max, mL/s		30.2 (22.2 – 39.8)	22.2 (19.5 – 26.4)	< 0.001
Δ Q_max, mL/s		21.2 (14.2 – 30.8)	15.5 (12.0 – 18.9)	0.037
% Δ Qmax		226 (172 – 335)	205 (152 – 295)	0.5
PVR, mL		0 (0 – 10)	0 (0 – 30)	0.004
IPSS		3 (1 – 6)	4 (2 – 6)	0.1
Δ IPSS		-16 (-25 – −11)	-21 (-24 – −17)	0.04
% Δ IPSS		-88 (-93 – −63)	-85 (-92 – −77)	0.9
QoL		1 (0 –1)	1 (1 – 2)	0.037
Δ QoL		-3 (-5 – −2.5)	-4 (-5 – −3)	0.003
% Δ QoL		-80 (-100 – −67)	-80 (-92 – −67)	1
IIEF-5		11 (5 – 21)	18 (14 – 21)	< 0.001
Δ IIEF-5		0 (0 – 0)	0 (-4 – 1)	0.5
% Δ IIEF-5		0 (0 – 0)	0 (-23.8 – 11.1)	0.3

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[1] Correspondence address: Riccardo Bertolo, MD, PhD San Carlo di Nancy Hospital-GVM Care & Research Via Aurelia 275, 00165 Rome, Italy. Telephone: + 3 906 3997-6504 E-mail: riccardobertolo@hotmail.it