Session: MP59: Benign Prostatic Hyperplasia: Surgical Therapy & New Technology III
MP59-02: INITIAL EXPERIENCE WITH SUPERPULSED THULIUM LASER IN PROSTATE ENUCLEATION: PROSPECTIVE RANDOMIZED MULTICENTER COMPARATIVE STUDY BETWEEN HOLEP AND THULEP IN TERMS OF EFFICACY AND SAFETY.
Introduction: Holmium laser enucleation of the prostate (HoLEP) is considered as the new “gold standard” to treat surgically BPH. Other types of lasers have been employed to enucleate, but with worse results or less evidence. The new Superpulsed Thulium laser available in the market offers new features that could be a good alternative. Our objective is to compare for the first time in the literature the efficacy and safety of HoLEP 100 Wat versus Superpulsed Thulium laser (TFL) 60 Wat enucleation of the prostate (ThuLEP) in the surgical treatment of BPH. Methods: Multicenter prospective comparative study of 100 patients randomized 1:1 to be treated with HoLEP vs. superpulsed ThuLEP (TFL), performed by 3 experts surgeons in laser enucleation. Inclusion criteria: patients with moderate/severe symptoms due to BPH. Exclusion criteria: Patients who have received other previous surgical treatment for BPH, urethral stenosis, bladder tumor, or lithiasis. A descriptive analysis of the groups was performed to compare: intraoperative, perioperative, and postoperative results at 3 and 6 months. Statistical significance was established at <0.005. Results: Both arms were similar in preoperative prostate volume, Q max, PSA, bladder catheterization, IPSS, and sexual function (measured by IIEF15). Total surgical time was longer in the HoLEP (mean of 52.90 min) vs. the ThuLEP group (45.55 min), (p=0.075). However, enucleation time was longer with the TFL (26.77 min vs. 23.90 min, p=0.09). No intraoperative complications were recorded. At the perioperative features: no differences between both groups were noted: bladder catheterization: 30.6 vs 32.4 hours, hospitalization 34.2 vs 36.8 hours. Drop in hemoglobin was similar in both groups (no transfusion was required). No differences were noted in: rehospitalization, emergency room, recatheterization, or infection. The resected tissue was 28gr vs 31gr. At three-month follow-up, the improvement in Q max was 14.00 ml/s and 10.75 ml/s for HoLEP and ThuLEP, respectively, but statistical significance was not reached. No differences were found in the IIEF-15 questionnaire and only one patient in each arm reported preserving ejaculatory function. The incontinence rate was slightly higher in the ThuLEP group but was equalized at 6-month follow-up. Conclusions: In expert hands, the first cases of prostatic enucleation with superpulsed Thulium laser (TFL) are comparable to Holmium laser in terms of functional results and post-surgical complications. SOURCE OF Funding: No
