Introduction: Thulium Laser Enucleation (ThuLEP) and Holmium Laser Enucleation of the Prostate (HoLEP) have shown excellent comparable outcomes in management of benign prostatic hyperplasia (BPH). The introduction of vapor-tunnel pulse-modulation allowed optimization of HoLEP for prostate surgery. It is unknown whether Vapor Tunnel Pulse-modulated HoLEP (VTPM-HoLEP) would offer superior operative efficacy and outcomes to ThuLEP, therefore we aimed to compare the two procedures in a contemporary cohort.
Methods: A prospective database of patients who underwent Laser enucleation of the prostate (LEP) between 2017 and 2021 was investigated. All LEPs were performed by a single experienced surgeon. Patients were stratified according to source of energy into ThuLEP and VTPM-HoLEP. Measures of efficacy included operative efficiency (resected tissue weight in grams/operative time in minutes) and enucleation efficiency (resected tissue weight/operative time). Propensity score weighted analysis was adopted to balance both groups and measures of operative efficacy, perioperative and postoperative outcomes were then evaluated.
Results: A total of 173 patients were identified, of which 98 (57%) underwent ThuLEP, 31 (18%) underwent conventional HoLEP and 42 (25%) underwent VTPM-HoLEP. Mean (SD) prostate size was 107.7 (64.8) gm, and there was no significant difference in prostate size between the two groups (106.3 [63.7] vs. 110.2 [67.4], p=0.77). After propensity score weighting, patients who underwent VTPM-HoLEP had a significantly shorter operative time (111.7 [38.3] minutes vs. 133.2 [48.7], p=0.027), higher operative efficiency (0.6 [0.3] vs. 0.4 [0.2] gm/min, p<0.001) and enucleation efficiency (0.7 [0.3] vs. 0.5 [0.2] gm/min, p=0.007) compared to ThuLEP. No difference was found in percentage of postoperative hemoglobin and hematocrit deficit, time to catheter removal, time to discharge or intra-operative complications.
Conclusions: VTPM-HoLEP offers superior operative efficacy in terms of operative time as well as operative and enucleation efficiency when compared to ThuLEP.
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