Long-term outcome following Thulium VapoEnucleation of the prostate

Abstract

Introduction: To evaluate Thulium VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) with long-term follow-up.

Methods: A prospective analysis of 124 patients who underwent ThuVEP between January 2007 and July 2008 at our institution was done. ThuVEP was carried out using the 70-Watt 2-μm continuous wave Tm:YAG laser. Patient demographic, perioperative complications, and follow-up data were analysed.

Results: The median (interquartile range) preoperative prostate volume was 58.5 (45-70.75) cc. The median operation and enucleation time were 74 (60-100) and 32.54 (25.62-37.52) min, respectively. The median catheter time and postoperative hospital stay were 2 (2-2) and 4 (3-5) days, respectively. Nine (7.3 %) patients required a second-look operation in the immediate postoperative course (failed morcellation = 2, clot retention = 3, and residual adenoma = 4). Two patients needed blood transfusions (1.6 %) postoperatively. At 12-month follow-up, International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoiding residual urine (PVR) improved significantly in comparison with preoperative assessment (p < 0.001). A significant decrease of median PSA (4.7 vs. 0.92 μg/l) was seen at one-year follow-up (p < 0.001). At the 48-month follow-up mark, Qmax, PVR, IPSS, and QoL still differed significantly from baseline (p < 0.001). Bladder neck contractures and urethral strictures each developed in 1.6 and 0.8 % of the patients during follow-up. None of the patients were re-treated during follow-up for recurrent prostatic tissue.

Conclusions: ThuVEP is a safe, efficacious, and durable procedure for the treatment of BPO. The incidence of late complications with ThuVEP was low.