High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group
Background: Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power...
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| Language: | English |
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Elsevier
2024-03-01
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| Series: | Prostate International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2287888223000727 |
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| author | Ee Jean Lim Daniele Castellani Bhaskar K. Somani Mehmet I. Gökce Khi Yung Fong Fernando G. Sancha Thomas R.W. Herrmann Sarvajit Biligere Azimdjon N. Tursunkulov Marco Dellabella Mario Sofer Dmitry Enikeev Vladislav Petov Nariman Gadzhiev Dean Elterman Abhay Mahajan Moises R. Socarras Dilmurod S. Yunusov Furkat Nasirov Jeremy Y.C. Teoh Vineet Gauhar |
| author_facet | Ee Jean Lim Daniele Castellani Bhaskar K. Somani Mehmet I. Gökce Khi Yung Fong Fernando G. Sancha Thomas R.W. Herrmann Sarvajit Biligere Azimdjon N. Tursunkulov Marco Dellabella Mario Sofer Dmitry Enikeev Vladislav Petov Nariman Gadzhiev Dean Elterman Abhay Mahajan Moises R. Socarras Dilmurod S. Yunusov Furkat Nasirov Jeremy Y.C. Teoh Vineet Gauhar |
| author_sort | Ee Jean Lim |
| collection | DOAJ |
| description | Background: Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power holmium laser (HPHL) in hands of experienced surgeons for large prostates (≥80 ml in volume). Secondary outcomes were assess complications within 1 year of follow up. Materials and Methods: We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centers (January 2019-January 2023). Patients with prostate volume ≥80 ml were included, while those with concomitant prostate cancer, previous prostate/urethral surgery, and pelvic radiotherapy were excluded. Results: Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470. After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed. Overall operative time (90 [70, 120] vs. 52.5 [39, 93] min, P < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, P = 0.914). In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis. In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation. Conclusions: This real-world study reaffirms that HPHL and TFL in large prostates are equally efficacious in terms of 30-day complications. TFL with the en-bloc technique has a shorter operative time which significantly improves short- and medium-term functional outcomes. |
| first_indexed | 2024-04-24T22:21:25Z |
| format | Article |
| id | doaj.art-744f0e09fcd74ef7a96c4b1e859eb45b |
| institution | Directory Open Access Journal |
| issn | 2287-8882 |
| language | English |
| last_indexed | 2024-04-24T22:21:25Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Prostate International |
| spelling | doaj.art-744f0e09fcd74ef7a96c4b1e859eb45b2024-03-20T06:09:30ZengElsevierProstate International2287-88822024-03-011214045High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study groupEe Jean Lim0Daniele Castellani1Bhaskar K. Somani2Mehmet I. Gökce3Khi Yung Fong4Fernando G. Sancha5Thomas R.W. Herrmann6Sarvajit Biligere7Azimdjon N. Tursunkulov8Marco Dellabella9Mario Sofer10Dmitry Enikeev11Vladislav Petov12Nariman Gadzhiev13Dean Elterman14Abhay Mahajan15Moises R. Socarras16Dilmurod S. Yunusov17Furkat Nasirov18Jeremy Y.C. Teoh19Vineet Gauhar20Department of Urology, Singapore General Hospital, Singapore; Corresponding author. Department of Urology, Singapore General Hospital, Outram Road, 169608, Singapore.Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, ItalyDepartment of Urology, University Hospital Southampton NHS Trust, Southampton, UKDepartment of Urology, Ankara University, School of Medicine, Ankara, TurkeyYong Loo Lin School of Medicine, National University of Singapore, SingaporeDepartment of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, SpainDepartment of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, SwitzerlandDepartment of Urology, Ng Teng Fong General Hospital, National University Health System, SingaporeUrology Division, Akfa Medline Hospital, Tashkent, UzbekistanUrology Unit, IRCCS INRCA, Ancona, ItalyDepartment of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, IsraelDepartment of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, RussiaDepartment of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, RussiaDepartment of Urology, Saint Petersburg State University Hospital, Saint Petersburg, RussiaDivision of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, CanadaDepartment of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, IndiaDepartment of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, SpainUrology Division, Akfa Medline Hospital, Tashkent, UzbekistanUrology Department, Tashkent Medical Academy, UzbekistanS.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, ChinaDepartment of Urology, Ng Teng Fong General Hospital, National University Health System, SingaporeBackground: Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power holmium laser (HPHL) in hands of experienced surgeons for large prostates (≥80 ml in volume). Secondary outcomes were assess complications within 1 year of follow up. Materials and Methods: We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centers (January 2019-January 2023). Patients with prostate volume ≥80 ml were included, while those with concomitant prostate cancer, previous prostate/urethral surgery, and pelvic radiotherapy were excluded. Results: Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470. After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed. Overall operative time (90 [70, 120] vs. 52.5 [39, 93] min, P < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, P = 0.914). In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis. In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation. Conclusions: This real-world study reaffirms that HPHL and TFL in large prostates are equally efficacious in terms of 30-day complications. TFL with the en-bloc technique has a shorter operative time which significantly improves short- and medium-term functional outcomes.http://www.sciencedirect.com/science/article/pii/S2287888223000727Endoscopic enucleation of the prostateLaser therapyProstatic hyperplasiaPostoperative complicationsUrinary incontinence |
| spellingShingle | Ee Jean Lim Daniele Castellani Bhaskar K. Somani Mehmet I. Gökce Khi Yung Fong Fernando G. Sancha Thomas R.W. Herrmann Sarvajit Biligere Azimdjon N. Tursunkulov Marco Dellabella Mario Sofer Dmitry Enikeev Vladislav Petov Nariman Gadzhiev Dean Elterman Abhay Mahajan Moises R. Socarras Dilmurod S. Yunusov Furkat Nasirov Jeremy Y.C. Teoh Vineet Gauhar High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group Prostate International Endoscopic enucleation of the prostate Laser therapy Prostatic hyperplasia Postoperative complications Urinary incontinence |
| title | High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group |
| title_full | High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group |
| title_fullStr | High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group |
| title_full_unstemmed | High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group |
| title_short | High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group |
| title_sort | high power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml results from the prostate endoscopic enucleation study group |
| topic | Endoscopic enucleation of the prostate Laser therapy Prostatic hyperplasia Postoperative complications Urinary incontinence |
| url | http://www.sciencedirect.com/science/article/pii/S2287888223000727 |
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