Thulium laser vaporesection of prostates with volume exceeding 100 cm ³ as an alternative to HoLEP and ThuLEP

Abstract

The aim of this study is to evaluate the outcomes of thulium laser vaporesection of prostates with volume exceeding 100 cm ³. In the present prospective study, patients with infra-vesical urinary obstruction due to a prostate with volume exceeding 100 cm ³ underwent endoscopic vaporesection using thulium laser. In this procedure, prostate chips were resected without morcellation. The technical aspects of surgery, admission time, post-operative catheter time and post-operative complications were analyzed. Flowmetry was performed combined with prostatic ultrasound in the follow-up. Between March 2010 and November 2018, 156 cases with benign prostatic hyperplasia (BPH; volume >100 cm ³) were treated. The mean patient age was 67.8 years (48.4–86.6 years), and the mean prostatic volume was 137 cm ³ (100–436 cm ³). The mean length of hospitalization was 1.48 days (1–8 days), and the mean post-operative catheter time was 5.1 (1–17). Three cases (1.9%) required readmission due to hematuria. The mean follow-up time was 31.2 months (standard deviation = 27.7). Urethral stricture was observed in 14 cases (9%), with bulbar urethra being the most frequent finding. Urinary tract infection was observed in 11 cases (7.1%), and urinary incontinence was observed in 5 cases. The mean peak urinary flow at 12 and 24 months was 26.9 ± 12.5 and 23.9 ± 11.7 ml/s, respectively, and the mean urinary flow during the final follow-up at 41 months was 21.6 ml/s. Thulium laser vaporesection is a valid alternative to open prostatectomy, HoLEP and ThuLEP in patients with large BPH. Urinary flow remained elevated throughout the follow-up.