Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results

doi:10.1007/s00345-019-02945-x

Randomized Controlled Trial

. 2020 Jun;38(6):1555-1562.

doi: 10.1007/s00345-019-02945-x. Epub 2019 Sep 9.

Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results

Junjie Zhang¹, Zhenyu Ou¹, Xiaobo Zhang¹, Wei He¹, Ruizhe Wang¹, Miao Mo¹, Lingxiao Chen¹, Ran Xu², Shusuan Jiang³, Xiaoyan Peng⁴, Lin Qi¹, Long Wang^{5

6}

Affiliations

¹ Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
² Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
³ Department of Urology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medical, Central South University, Changsha, 410013, Hunan, China.
⁴ Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
⁵ Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. wanglong@csu.edu.cn.
⁶ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. wanglong@csu.edu.cn.

PMID: 31502032
DOI: 10.1007/s00345-019-02945-x

Randomized Controlled Trial

Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results

Junjie Zhang et al. World J Urol. 2020 Jun.

. 2020 Jun;38(6):1555-1562.

doi: 10.1007/s00345-019-02945-x. Epub 2019 Sep 9.

Authors

Junjie Zhang¹, Zhenyu Ou¹, Xiaobo Zhang¹, Wei He¹, Ruizhe Wang¹, Miao Mo¹, Lingxiao Chen¹, Ran Xu², Shusuan Jiang³, Xiaoyan Peng⁴, Lin Qi¹, Long Wang^{5

6}

Affiliations

¹ Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
² Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
³ Department of Urology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medical, Central South University, Changsha, 410013, Hunan, China.
⁴ Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
⁵ Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. wanglong@csu.edu.cn.
⁶ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. wanglong@csu.edu.cn.

PMID: 31502032
DOI: 10.1007/s00345-019-02945-x

Abstract

Purpose: To compare the perioperative and functional outcomes of holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) for the treatment of large-volume benign prostatic hyperplasia (BPH) (> 80 ml).

Methods: A total of 116 consecutive patients with BPH were randomized to be treated surgically with either HoLEP (n = 58) or ThuLEP (n = 58), following the classical three-lobe enucleation technique. Follow-up was assessed at 1, 3, 6, 12 and 18 months after surgery.

Results: At 18 months, the lower urinary tract symptom index was improved significantly in both groups compared with the baseline values. The operative time (78.4 ± 8.0 vs. 71.4 ± 6.4 min) and enucleation time (61.2 ± 5.4 vs. 56.4 ± 8.4 min) were significantly shorter for ThuLEP compared to HoLEP (both p < 0.001). There were no significant differences between the two groups regarding morcellation time, resected weight, hemoglobin decrease, catheter time and hospital stay (p > 0.05). The HoLEP and ThuLEP groups had equivalent International Prostate Symptom Scores (3 [3-3] vs. 3 [3-3], p = 0.776), quality of life (1 [1-2] vs. 2 [1-2], p = 0.809), Qmax (25.3 ± 4.8 ml/s vs. 24.7 ± 4.4 ml/s, p = 0.470), postvoid residual urine (PVR) (6.1 [2.6-20.8] vs. 7.7 [3.1-22.8] ml, p = 0.449) and PSA (0.84 ± 0.32 vs. 0.90 ± 0.34 ml, p = 0.309) at 18 months postoperatively.

Conclusion: Both HoLEP and ThuLEP relieve lower urinary tract symptoms in a comparable way with high efficacy and safety. ThuLEP was statistically superior to HoLEP in operation time and enucleation time, although the differences were clinically negligible.

Keywords: Benign prostatic hyperplasia (BPH); HoLEP; Large-volume prostate; Randomized controlled trial (RCT); ThuLEP.

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References

1. Becker B, Herrmann TRW, Gross AJ, Netsch C (2018) Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J Urol 36(10):1663–1671. https://doi.org/10.1007/s00345-018-2321-8 - DOI - PubMed
1. Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, Cestari A, Briganti A, Mazzoccoli B, Rigatti P, Montorsi F (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates > 70 g: 24-month follow-up. Eur Urol 50(3):563–568. https://doi.org/10.1016/j.eururo.2006.04.003 - DOI - PubMed
1. Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017 - DOI - PubMed
1. Yang Z, Wang X, Liu T (2013) Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up. Urology 81(2):396–400. https://doi.org/10.1016/j.urology.2012.08.069 - DOI - PubMed
1. Elshal AM, Elkoushy MA, El-Nahas AR, Shoma AM, Nabeeh A, Carrier S, Elhilali MM (2015) GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 193(3):927–934. https://doi.org/10.1016/j.juro.2014.09.097 - DOI - PubMed

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[1] Becker B, Herrmann TRW, Gross AJ, Netsch C (2018) Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J Urol 36(10):1663–1671. https://doi.org/10.1007/s00345-018-2321-8 - DOI - PubMed

[2] Becker B, Herrmann TRW, Gross AJ, Netsch C (2018) Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J Urol 36(10):1663–1671. https://doi.org/10.1007/s00345-018-2321-8 - DOI - PubMed

[3] Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, Cestari A, Briganti A, Mazzoccoli B, Rigatti P, Montorsi F (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates > 70 g: 24-month follow-up. Eur Urol 50(3):563–568. https://doi.org/10.1016/j.eururo.2006.04.003 - DOI - PubMed

[4] Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, Cestari A, Briganti A, Mazzoccoli B, Rigatti P, Montorsi F (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates > 70 g: 24-month follow-up. Eur Urol 50(3):563–568. https://doi.org/10.1016/j.eururo.2006.04.003 - DOI - PubMed

[5] Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017 - DOI - PubMed

[6] Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017 - DOI - PubMed

[7] Yang Z, Wang X, Liu T (2013) Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up. Urology 81(2):396–400. https://doi.org/10.1016/j.urology.2012.08.069 - DOI - PubMed

[8] Yang Z, Wang X, Liu T (2013) Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up. Urology 81(2):396–400. https://doi.org/10.1016/j.urology.2012.08.069 - DOI - PubMed

[9] Elshal AM, Elkoushy MA, El-Nahas AR, Shoma AM, Nabeeh A, Carrier S, Elhilali MM (2015) GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 193(3):927–934. https://doi.org/10.1016/j.juro.2014.09.097 - DOI - PubMed

[10] Elshal AM, Elkoushy MA, El-Nahas AR, Shoma AM, Nabeeh A, Carrier S, Elhilali MM (2015) GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 193(3):927–934. https://doi.org/10.1016/j.juro.2014.09.097 - DOI - PubMed

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Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results

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Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results

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