Thulium Laser Enucleation of the Prostate (ThuLEP) as a Technique for Treatment of BPH: Evaluation of a Six-Year Experience at a Single Institution

Main Article Content

Mahmood Vazirian-Zadeh
Jane Anderson
Ravine Gill
Islam Noaman
Katie Lee
Henryk Krasnowski
KJ Ho

Abstract

Background and objective
Transurethral resection of the prostate (TURP) has been the undisputed reference standard for elderly men with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE).
However, morbidity after TURP remains significant, with increased risks of bleeding and TUR syndrome.
In recent years, there has been a gradual increase in the role of laser technology for the treatment of symptomatic BPE.


The aim of our study was to evaluate the efficacy and safety of the novel technique Thulim laser enucleation of prostate (ThuLEP) developed for the first time in 2009 by Imkamp et al. in treating symptomatic BPE.


Materials and methods
Analysis of the data from electronic records, case notes, clinic letters all the patients who had undergone ThuLEP using a 70 W thulium laser (Revolix) for symptomatic outflow obstruction over a 6-year period was done.
We looked at the pre-procedure PSA, maximum urinary flow rate (Qmax), Post void residual (PVR) and haemoglobin, comparing it with the postoperative haemoglobin.


Results
222 patients underwent ThuLEP procedure performed by 2 surgeons.
We found a 159 % improvement in Q max, a 61 % improvement in PVR.
No mortalities occurred and only 1 patient required post operative blood transfusion.


ThuLEP represents a safe, effective surgical option in patients with symptomatic BPH with relatively little complications, producing significant improvements in both Qmax and PVR.


Key words


LUTS, BPE, Enucleation, TUR Syndrome, Qmax

Downloads

Download data is not yet available.

Article Details

How to Cite
Vazirian-Zadeh, M., Anderson, J., Gill, R., Noaman, I., Lee, K., Krasnowski, H., & Ho, K. (2018). Thulium Laser Enucleation of the Prostate (ThuLEP) as a Technique for Treatment of BPH: Evaluation of a Six-Year Experience at a Single Institution. Journal of Endoluminal Endourology, 1(2), e10-e14. https://doi.org/10.22374/jeleu.v1i2.21
Section
Original Article
Author Biographies

Jane Anderson, Russell’s Hall Hospital, Dudley, UK.

Department of Urology

Ravine Gill, Queen Elizabeth Hospital, Birmingham, UK.

Department of Urology 

Islam Noaman, Victoria Hospital Kirkcaldy,Scotland, Ain Shams University, Cairo, Egypt

Department of General Surgery Victoria Hospital Kirkcaldy, Scotland,  Lecturer of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Katie Lee, Russell’s Hall Hospital, Dudley, UK.

Department of Urology

Henryk Krasnowski, Russell’s Hall Hospital, Dudley, UK.

Department of Urology

KJ Ho, Russell’s Hall Hospital, Dudley, UK

Department of Urology

References

1. Litwin M, Saigal C, Beerbohm E. The burden of urologic diseases in America. J Urol. 2005;173(4):1065-1066.
2. Saigal C, Joyce G. Economic costs of benign prostatic hyperplasia in the private sector. J Urol. 2005;173(4):1309-1313.
3. Maximilian Rom, Georg Schatzl, Natalia Swietek ,et al. Lower urinary tract symptoms and depression. BJU International. 2012; 110(11):918-921
4. Malaeb B, Yu X, McBean A, et al. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000- 2008). Urology. 2012;795):1116-1117.
5. Mebust WK, Holtgreve HL, Cockett ATK, et al. Transurethral prostatectomy: immediate postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol. 2002;167(1):5-9.
6. De la Rosette J, Alivizatos G. Lasers for the treatment of bladder outlet obstruction: are they challenging conventional treatment modalities? Eur Urol 2006;50(3):418–20.
7. Elzayat EA, Elhilali MM. Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy. Eur Urol 2006;49(1):87–91.
8. Fried NM, Murray KE. High-power thulium fiber laser ablation of urinary tissues at 1.94 mm. J Endourol 2005; 19(1):25–31.
9. Baazeem A, Elhilali MM. Surgical management of benign prostatic hyperplasia: current evidence. Nat Clin Pract Urol. 2008;5:540-549.
10. Elmansy H, Elzayat E, Elhilali M. Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: long-term results of a randomized trial. J Urol. 2010;184(5):2023-2028.
11. Tan A, Gilling P, Kennett K, et al. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003;170(4):1270-1274.
12. Westenberg A, Gilling P, Kennett K, et al. Holmium laser resection of the prostate versus transurethral resection of the prostate: results at 6 years. Eur Urol. 2008;53 (4):744-749.
13. Johann P. Ingimarsson, Benjamin W. Herrick, Ronald L. Yap, Ambulatory Pathway Laser Prostate Surgery in Severely Ill Patients e Feasibility and Short-term Outcomes, Urology, 2016; 83 (3) 576-580.
14. 1. Xia S, Zhuo J, Sun X, et al. Thulium Laser versus Standard Transurethral Resection of the Prostate: A Randomized Prospective Trial. Eur Urol, 2008; 53 (2): 382-390.
15. 3. Kuntz R. Current Role of Lasers in the Treatment of Benign Prostatic Hyperplasia (BPH). Eur Urol 2006; 49 (6): 961-969.