MP04-17: A matched-paired comparison of a novel pulsed Thulium:YAG laser with a continuous wave Thulium fibre laser and a Holmium:YAG laser for endoscopic enucleation of the prostate (EEP)

Christopher Netsch*, Benedikt Becker, Clemens Rosenbaum, Andreas Gross, Hamburg, Germany

Introduction: A pulsed Tm:YAG laser has been currently introduced for EEP. Aim of this study was to compare the perioperative results of pulsed Thulium laser enucleation of the prostate (pThuLEP), continuous wave Thulium VapoEnucleation of the prostate (cwThuVEP) and Holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic obstruction (BPO).

Methods: A retrospective matched-paired comparison of 120 patients with symptomatic BPO treated with pThuLEP (n=40), cwThuVEP (n=40), and HoLEP (n=40) was done. EEP was carried out using a pulsed Tm:YAG laser (RevoLix® HTL, LISA Laser products, Katlenburg, Germany), a cw Tm:fibre laser (vela®XL, Boston Scientific, Ratingen, Germany) or a Ho:YAG laser (Auriga®XL, Boston Scientific, Ratingen, Germany).The groups were compared regarding perioperative parameters, functional outcomes (International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR)), and the perioperative complications. Patient data were expressed as median (interquartile range) or numbers (%).

Results: There were no differences between the groups pre-operatively. Median age was 72.5 (67-76) yrs., prostate volume 63.5 (45-100) gm, and ASA score 2 (2-3). 22 patients (18.3%) were treated under continuous aspirin therapy. Anticoagulant therapy was temporarily stopped in 17 (14.2%) patients. The operative time was 51 (33.5-73.5) min and was significantly different between HoLEP and pThuLEP (65 vs. 43 min, p<0.043). There were no differences between the groups regarding resected weight (48 (25-76) g), Hb decrease (1.8 (0.8-2.6) g/dl), catheter time (2 (2-2) days) and postoperative stay (2 (2-3) days). Clavien 1 (13.3%), Clavien 2 (3.3%), Clavien 3b (5.8%), and Clavien 4a (0.8%) complications occurred without differences between the groups. One blood (0.8%) transfusion was necessary after cwThuVEP. A secondary morcellation was carried out in 2 patients (1.7%, n=1 ThuVEP, n=1 HoLEP) and 5 patients needed a coagulation of the prostatic fossa (4.2%; HoLEP (n=2), cwThuVEP (n=1), pThuLEP (n=2)). At discharge, Qmax (10 vs. 16.6 ml/s), PVR (150 vs. 30 ml), IPSS (21 vs. 13), and QoL (4 vs. 3) differed significantly from baseline (p < 0.001). However, Qmax was significantly different between HoLEP and pThuLEP (13.7 vs. 18.55 ml/s, p<0.02) at discharge.

Conclusions: Thulium and Holmium lasers are safe and effective for EEP in patients with symptomatic BPO. Pulsed ThuLEP might decrease the operative time of EEP.

Source of Funding: -