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. 2024 Mar;65(2):139-147.
doi: 10.4111/icu.20230270.

Propensity score-matched analysis comparing perioperative, functional, and safety outcomes between thulium fiber laser and bipolar enucleation of the prostate performed by a single surgeon with two years of follow-up

Armais Albertovich Kamalov  1 , Nikolay Ivanovich Sorokin  1 , Vitaly Kazichanovich Dzitiev  1 , Andrey Alekseevich Strigunov  1 , Olga Yurevna Nesterova  2 , Ilya Vladimirovich Bondar  1
Affiliations

Propensity score-matched analysis comparing perioperative, functional, and safety outcomes between thulium fiber laser and bipolar enucleation of the prostate performed by a single surgeon with two years of follow-up

Armais Albertovich Kamalov et al. Investig Clin Urol. 2024 Mar.

Abstract

Purpose: To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (ThuFLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis.

Materials and methods: Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release.

Results: Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar.

Conclusions: ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia.

Keywords: Benign prostatic hyperplasia; Minimally invasive surgical procedure; Propensity score; Thulium.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1. Comparison of IPSS, QoL score, Qmax, and PVR before and after bipolar enucleation and ThuFLEP during 24 months of follow-up. Values are presented as mean. IPSS, International Prostate Symptom Score; QoL, quality of life; Qmax, maximum speed of urine flow; PVR, postvoid residual volume; preop, preoperative; ThuFLEP, thulium fiber laser enucleation of the prostate.
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