nach oben

Lasers in Medical Science

Erschienen in:

05.03.2019 | Original Article

Thulium vapoenucleation of the prostate (ThuVEP) for prostates larger than 85 ml: long-term durability of the procedure

verfasst von: Benedikt Becker, Ann Kathrin Orywal, Andreas J. Gross, Christopher Netsch

Erschienen in: Lasers in Medical Science | Ausgabe 8/2019

Einloggen, um Zugang zu erhalten

Abstract

The purpose of this prospective study of 90 consecutive patients is to assess the long-term durability of ThuVEP in patients with benign prostatic hyperplasia (BPH) and prostate volumes ≥ 85 ml. Ninety patients with prostates ≥ 85 ml underwent ThuVEP between 2008 and 2010 at our institution. Patient demographics and short-term and long-term follow-up were evaluated. Maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), quality of life (QoL), complications, and PSA were assessed at follow-up. Median age at surgery was 71 (66–75.25) years. Thirty-seven (41.1%) of the patients were in urinary retention at the time of surgery. Prostate volume was 100 (88–122) ml. Median follow-up was 36.5 (16–60) months. At 12-month follow-up, IPSS, QoL, Qmax, and PVR had improved significantly compared with preoperative assessment and continued to do so during follow-up (p < 0.001). At 4-year postoperative, median Qmax (19.1 vs. 7.75 ml/s), PVR (31.9 vs. 150 ml), IPSS (4.5 vs. 24), and QoL (1 vs. 5) differed significantly from baseline (p ≤ 0.027). PSA decreased from 7.4 (4.14–14) to 0.70 (0.36–1.64) μg/l (p < 0.001) at 48-month follow-up, corresponding to a PSA reduction of 86.48% (79.85–95.25%). Urinary tract infections occurred in 2 (2.2%) patients. Urethral stricture and bladder neck contracture developed in 1 (1.1%) patient each. One patient (1.1%) had recurrent adenoma of the prostate and was treated with thulium vaporesection of the prostate. ThuVEP is a durable modern alternative to open prostatectomy for patients with substantially enlarged prostates due to BPH. The incidence of complications with ThuVEP during long-term follow-up was low.

Gratzke C, Schlenker B, Seitz M et al (2007) Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol 177:1419–1422. https://doi.org/10.1016/j.juro.2006.11.062 CrossRefPubMed

Ahyai SA, Gilling P, Kaplan SA et al (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58:384–397. https://doi.org/10.1016/j.eururo.2010.06.005 CrossRefPubMed

Elzayat EA, Habib EI, Elhilali MM (2005) Holmium laser enucleation of the prostate: a size-independent new “gold standard”. Urology 66:108–113. https://doi.org/10.1016/j.urology.2005.06.006 CrossRefPubMed

Elzayat EA, Elhilali MM (2006) Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy. Eur Urol 49:87–91. https://doi.org/10.1016/j.eururo.2005.08.015 CrossRefPubMed

Fraundorfer MR, Gilling PJ (1998) Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 33:69–72CrossRefPubMed

Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 53:160–166. https://doi.org/10.1016/j.eururo.2007.08.036 CrossRefPubMed

Krambeck AE, Handa SE, Lingeman JE (2013) Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 189:S141–S145. https://doi.org/10.1016/j.juro.2012.11.027 CrossRefPubMed

Elmansy HM, Kotb A, Elhilali MM (2011) Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of followup. J Urol 186:1972–1976. https://doi.org/10.1016/j.juro.2011.06.065 CrossRefPubMed

Cornu J-N, Ahyai S, Bachmann A et al (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 67:1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017 CrossRefPubMed

10.

Gilling PJ (2013) Laser enucleation is increasingly becoming the standard of care for treatment of benign prostatic hyperplasia of all sizes. Eur Urol 63:868–869; discussion 870-871. https://doi.org/10.1016/j.eururo.2013.01.001 CrossRefPubMed

11.

Bach T, Wendt-Nordahl G, Michel MS et al (2009) Feasibility and efficacy of thulium:YAG laser enucleation (VapoEnucleation) of the prostate. World J Urol 27:541–545. https://doi.org/10.1007/s00345-008-0370-0 CrossRefPubMed

12.

Netsch C, Engbert A, Bach T, Gross AJ (2014) Long-term outcome following thulium VapoEnucleation of the prostate. World J Urol 32:1551–1558. https://doi.org/10.1007/s00345-014-1260-2 CrossRefPubMed

13.

Bach T, Netsch C, Pohlmann L et al (2011) Thulium:YAG vapoenucleation in large volume prostates. J Urol 186:2323–2327. https://doi.org/10.1016/j.juro.2011.07.073 CrossRefPubMed

14.

Gross AJ, Netsch C, Knipper S et al (2013) Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: results at a single institution. Eur Urol 63:859–867. https://doi.org/10.1016/j.eururo.2012.11.048 CrossRefPubMed

15.

Gravas S, Bach T, Bachmann A, et al (2016) Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), including benign prostatic obstruction (BPO). Eur Urol 67(6):1099-1109. https://doi.org/10.1016/j.eururo.2014.12.038

16.

Zhu L, Chen S, Yang S et al (2013) Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70 ml: a prospective, randomized trial with 5-year followup. J Urol 189:1427–1431. https://doi.org/10.1016/j.juro.2012.10.117 CrossRefPubMed

17.

Chen S, Zhu L, Cai J et al (2014) Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: a randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol 66:284–291. https://doi.org/10.1016/j.eururo.2014.01.010 CrossRefPubMed

18.

Madersbacher S, Lackner J, Brössner C et al (2005) Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol 47:499–504. https://doi.org/10.1016/j.eururo.2004.12.010 CrossRefPubMed

19.

Netsch C, Bach T, Herrmann TRW et al (2013) Evaluation of the learning curve for thulium VapoEnucleation of the prostate (ThuVEP) using a mentor-based approach. World J Urol 31:1231–1238. https://doi.org/10.1007/s00345-012-0894-1 CrossRefPubMed

20.

Pearce SM, Pariser JJ, Malik RD et al (2016) Outcomes following thulium vapoenucleation of large prostates. Int Braz J Urol Off J Braz Soc Urol 42:757–765CrossRef

21.

Netsch C, Bach T, Herrmann TRW, Gross AJ (2012) Thulium:YAG VapoEnucleation of the prostate in large glands: a prospective comparison using 70- and 120-W 2-μm lasers. Asian J Androl 14:325–329. https://doi.org/10.1038/aja.2011.167 CrossRefPubMedPubMedCentral

22.

Yang Z, Liu T, Wang X (2016) Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up. Lasers Med Sci 31:1797–1802. https://doi.org/10.1007/s10103-016-2052-2 CrossRefPubMed

23.

Kuo RL, Kim SC, Lingeman JE et al (2003) Holmium laser enucleation of prostate (HoLEP): the Methodist Hospital experience with greater than 75 gram enucleations. J Urol 170:149–152. https://doi.org/10.1097/01.ju.0000070686.56806.a1 CrossRefPubMed

24.

Tinmouth WW, Habib E, Kim SC et al (2005) Change in serum prostate specific antigen concentration after holmium laser enucleation of the prostate: a marker for completeness of adenoma resection? J Endourol 19:550–554. https://doi.org/10.1089/end.2005.19.550 CrossRefPubMed

25.

Netsch C, Bach T, Herrmann TRW, Gross AJ (2015) Update on the current evidence for tm:YAG vapoenucleation of the prostate 2014. World J Urol 33:517–524. https://doi.org/10.1007/s00345-014-1417-z CrossRefPubMed

26.

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. https://doi.org/10.1007/s00345-018-2321-8

27.

Reich O, Gratzke C, Bachmann A et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180:246–249. https://doi.org/10.1016/j.juro.2008.03.058 CrossRefPubMed

28.

Ruszat R, Seitz M, Wyler SF et al (2008) GreenLight laser vaporization of the prostate: single-center experience and long-term results after 500 procedures. Eur Urol 54:893–901. https://doi.org/10.1016/j.eururo.2008.04.053 CrossRefPubMed

Titel: Thulium vapoenucleation of the prostate (ThuVEP) for prostates larger than 85 ml: long-term durability of the procedure
verfasst von: Benedikt Becker
Ann Kathrin Orywal
Andreas J. Gross
Christopher Netsch
Publikationsdatum: 05.03.2019
Verlag: Springer London
Erschienen in: Lasers in Medical Science / Ausgabe 8/2019
Print ISSN: 0268-8921
Elektronische ISSN: 1435-604X
DOI: https://doi.org/10.1007/s10103-019-02760-1

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Thulium vapoenucleation of the prostate (ThuVEP) for prostates larger than 85 ml: long-term durability of the procedure

Abstract

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2019

Low-level laser therapy as a modifier of erythrocytes morphokinetic parameters in hyperadrenalinemia

Photodynamic antimicrobial chemotherapy has an overt killing effect on periodontal pathogens? A systematic review of experimental studies

Low-level laser therapy affects dentinogenesis and angiogenesis of in vitro 3D cultures of dentin-pulp complex

Efficacy of laser treatment for onychomycotic nails: a systematic review and meta-analysis of prospective clinical trials

In vitro bioactivity of laser surface-treated Ti6Al4V alloy

Evaluation of nonlinear optical behavior of mouse colon cancer cell line CT26 in hyperthermia treatment