Uroflowmetry (UFR). A: Maximum urinary flow rate (Qmax) according to the UFR test data. No statistical differences were observed in the two groups. B: Postvoid residual volume in the UFR test data. All variables improved significantly in the two groups after the operation without statistical differences at later follow-up examinations.

Uroflowmetry (UFR). A: Maximum urinary flow rate (Qmax) according to the UFR test data. No statistical differences were observed in the two groups. B: Postvoid residual volume in the UFR test data. All variables improved significantly in the two groups after the operation without statistical differences at later follow-up examinations.

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Prostate vaporization and enucleation is a novel treatment option for bladder outlet obstruction caused by benign prostate enlargement. This surgical technique, however, has not yet been standardized. We present our findings of using a high-power thulium laser to accomplish vapoenucleation of the prostate (ThuVEP). We prospectively collected and an...

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... Holmium laser ablates tissue effectively and is safe thanks to its pulsed nature and 0.4 mm penetration depth [1,2]. Numerous authors have focussed on the clinical outcome of laser procedures and device settings [4,8,10,11]. In a randomised controlled trial, Elshal et al. showed that the LP-HoLEP (2 J/25 Hz) and HP-HoLEP (2 J/50 Hz) are comparable in terms of enucleation efficiency regardless of the surgeon's experience (1.42 ± 0.6 g/min vs. 1.47 ± 0.6 g/min, respectively) [11]. ...
... The efficiency and safety of (CW) Tm:YAG application have been investigated [10,13,14]. Yet experimental studies performed on real tissue are scarce. ...
Article
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Purpose The aim of this study was to compare the enucleation performances of four different types of laser devices in an ex-vivo experiment: a novel, pulsed Tm:YAG solid-state laser evaluation model (p-Tm:YAG), chopped thulium fibre laser (TFL), low-power Ho:YAG laser (LP-Ho:YAG), and a high-power Ho:YAG laser (HP-Ho:YAG). Methods Our primary aim was to endoscopically separate the fascial layers of a porcine belly using laser fibres within a time period of 60 s. The size of a “tissue pocket” was assessed numerically. The enucleation characteristics reflecting the surgeon’s experience were evaluated via the NASA Task Load Index (TLX) questionnaire and a questionnaire based on Likert scale. Results HP-Ho:YAG achieved with the available laser settings the largest overall “tissue pocket” (31.5 cm ² ) followed by p-Tm:YAG (15 cm ² ), TFL (12 cm ² ), and LP-Ho:YAG (6 cm ² ). The coagulation performances of p-Tm:YAG and TFL were rated the best. In the performance evaluation by the Likert questionnaire, HP-Ho:YAG (average score of 4.06) was rated highest, followed by p-Tm:YAG (3.94), TFL (3.38), and LP-Ho:YAG (3.25). The evaluation of the NASA-TLX performance questionnaire revealed average scores for HP-Ho:YAG, LP-Ho:YAG, TFL and p-Tm:YAG of 4.38, 4.09, 3.92 and 3.90, respectively. Conclusion We are the first to compare different laser devices and settings in an ex-vivo study. We found that the surgeons were most satisfied with the HP-Ho:YAG laser device, followed by the p-Tm:YAG. These findings could be highly relevant for future research and for the practical utilisation of laser systems in endourology.
... After a 3-month follow-up, micturition improvement was equivalent in both groups [18]. Similar results were published by Chang et al. in a comparison between ThuVEP and TURP [19]. Again, the resected tissue was higher in the TURP group. ...
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Purpose To summarize the current evidence and the reasons to go for thulium-based anatomical endoscopic enucleation of the prostate (AEEP). Methods This review discusses the available literature on thulium-based AEEP. Results Thulium lasers operate at a wavelength between 1940 and 2013 nm. This wavelength, which has a low penetration depth in water, allows to perform smooth cuts in the prostatic tissue and allows urologists to perform various procedures: resection, vaporization, enucleation, or vapoenucleation of the prostate. Depending on the type of thulium laser, it can be used either in a continuous, or pulsed mode. Conclusion In recent years, an increasing amount of evidence has described the thulium laser as a minimally invasive and size-independent treatment option for benign prostatic enlargement with excellent long-term results.
... Chang et al. compared prospective outcomes of 29 patients who underwent ThuVEP to 30 patients who underwent TURP (2010-2012) [38]. Preoperative voiding parameters were compared to 1-year follow-up data with significant improvements of voided volume, Qmax, PVR, and mean flow rate in both groups. ...
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Purpose of Review The purpose of this review is to summarize the literature on safety and efficacy of minimally invasive thulium laser procedures for benign prostatic hypertrophy (BPH). Recent Findings Recent studies have confirmed long-term safety and efficacy of thulium laser prostatectomy. There has been recent literature published from around the world confirming safety and efficacy in treatment of large prostates, obese patients, and in patients taking oral anticoagulation. Newer thulium laser systems use a wavelength of 1.9μm instead of 2 μm. Thus far, no clinical differences have been seen in outcomes of thulium laser procedures done with this wavelength. Summary The high-power thulium laser was first introduced in 2005 for treatment of BPH [1]. Thulium vapoenucleation (ThuVEP), thulium laser resection of the prostate-tangerine technique (TmLRP), thulium laser enucleation (ThuLEP), and thulium vaporization (ThuVP) are techniques for thulium laser prostatectomy that have been described. Studies using the 70W to 200W thulium laser systems demonstrated good efficacy of these procedures with low morbidity and few complications in prostates of small to medium sizes [2]. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP, and holmium laser enucleation of prostate (HoLEP) [1]. In general, thulium laser prostatectomy appears to have longer operative times, shorter catheterization times, shorter hospital stay, and lower transfusion rates compared to standard and bipolar TURP. Outcomes of HoLEP and thulium enucleation techniques appear to be similar. Overall, thulium laser prostatectomy appears to be very safe and effective with low morbidity [3].
... These data have been mentioned in a series of recent specialized publications. Thus, the study presented by Lin and Chang reported total complication rates of 20.7% vs 30% (ThuVEP vs TURP), which coincides with the data obtained in our study (17.5% -ThuVEP, and 33.9% -TURP), thus supporting the data reported in the pertinent literature 23 . The low incidence rate of grade II, III and III b complications (blood transfusions, urinary tract infections, urethral strictures, and bladder neck sclerosis) assessed according to the Clavien-Dindo classification (2004) are similar to data retrieved from specialized literature and thus fully confirm the operational safety of ThuVEP 1,24 . ...
Article
Introduction. Thulium:YAG laser has been increasingly used in retrograde transurethral enucleation of the prostate as a new advanced surgical treatment in benign prostatic hyperplasia (BPH). The implementation of Thulium:YAG laser prostatic vapoenucleation (ThuVEP) will allow patients with large BPH, who have traditionally been treated via open adenomectomy or monopolar transurethral resection, to undergo minimally invasive endoscopic treatment by using laser energy. The objective of the study was to provide a comparative assessment of ThuVEP vs. standard transurethral resection (TURP) in the treatment of benign prostatic hyperplasia. Material and methods. The study was conducted on 81 patients with BPH, regarding the appropriate surgical treatment, including ThuVEP (40 patients) and TURP (41 patients), from May to December 2018. All patients were assessed before surgery and 3, 6 and 12 months after surgery. The obtained data were compared retrospectively. Results. ThuVEP has proven its long-expected surgical efficacy. The main urodynamic and ultrasonographic indices at 12 months postoperatively showed no statistically significant difference. Moreover, the incidence rate of surgical complications was lower in the ThuVEP group. Patients from the ThuVEP group did not require further blood transfusions. Conclusions. ThuVEP exhibited major efficacy and maximum efficiency in the treatment of BPH in our study. Thulium:YAG laser used in the surgical treatment of BPH is considered superior compared to the classic TURP endourological technique, as well as promising for clinical practice. Further long-term patients’ follow-up is necessary to assess the durability of the intervention.
... Chang et al were the first to compare ThuVEP vs monopolar TURP (29 and 30 patients, respectively). 63 The resected tissue was higher in the TURP group than in the ThuVEP group Five-year follow-up in 80 patients showed maintained improvements in LUTS and micturition compared to baseline, and no statistical difference was demonstrated between the groups. 66 Bozzini et al confirmed Yang's results in a randomized trial in 208 men. ...
Article
Tm:YAG laser operates at a wavelength of 1940-2013 nm in a continuous wave mode, which enables smooth incision and rapid vaporization of prostatic tissue, with a shallow penetration of only 0.2 mm. These characteristics make Tm:YAG a versatile laser, allowing the surgeon to perform resection, vaporization, and vapoenucleation. This systematic review aims to summarize the current evidence of safety and efficacy, long-term durability, impact on sexual function following Tm:YAG laser enucleation and vapoenucleation of the prostate and to compare the outcomes of these procedures versus other surgical treatments of benign prostatic hyperplasia.
... The power of an advanced thulium device is 150-200 W. In our pilot study published in 2015, a high-power thulium laser was used to perform ThuLEP in patients from the general or unselected public. One year of follow-up showed that ThuLEP and traditional transurethral resection of the prostate (TURP) effectively alleviated subjective and objective voiding symptoms with a low rate of complications [15]. Limited evidence described favorable outcomes with ThuLEP that were comparable with those with OP, TURP, and HoLEP for prostates < 80 mL [16,17]. ...
... Postoperative Foley catheter irrigation was performed, and then the catheter was removed the day after surgery. Patients who underwent ThuLEP during our pilot study were considered as a control group [15]. Data regarding surgical variables, patient status, preoperative and postoperative urinary flow rates, prostate volume, and the international prostate symptom score (IPSS) were extracted from each patient's medical records. ...
... The database from published articles were introduced as the the OP, HoLEP, and ThuLEP control group [15,20,21]. Data were analyzed using Student's t-test, the z-test, and logistic regression analysis with MedCalc software (Medcalc, Mariakerke, Belgium). ...
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Background The efficacy of thulium laser prostate enucleation (ThuLEP) for large prostates is unclear. This study aimed to explore the expanded utility of 150–200-W ThuLEP by studying patients with a large prostate (> 80 mL). Methods We retrospectively reviewed records of 125 patients with large prostate glands (> 80 mL) who underwent ThuLEP performed by a single surgeon from June 2012 to June 2016. The ThuLEP data from our previous pilot study were used as the control. Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume, and the international prostate symptom score (IPSS) were recorded and analyzed using Student’s t-test, the z-test, and logistic regression analysis. Results Of 366 patients who underwent ThuLEP, 125 (34.15%) were enrolled. The ages and estimated prostate volumes were compared with those of the control. Overall, 39.2% underwent Foley placement and 4% received an anticoagulant agent preoperatively. Maximum urinary flow rates before and 3 and 12 months postoperatively were 9.93, 23.20, and 19.00 mL/s, respectively, which were generally equal to those of the control groups (P = 0.68, 0.18, 0.98, respectively). Preoperative and postoperative IPSSs were 27.09 and 7.35, respectively. The postoperative prostate-specific antigen was reduced by 85.59% in comparison to the preoperative level. The estimated prostate size was reduced by 74.17% postoperatively. The modified Clavien-Dindo classification system was used to identify the overall rate of complications, which was approximately 22.4%. The mortality rate was 0.8%. Conclusions High-power ThuLEP is safe and effective for patients with large prostate glands (> 80 mL). Prostate enucleation using a high-power thulium laser is feasible for patients who exhibit contraindications for surgery.
... 14 Thulium vapoenucleation of the prostate (ThuVEP) have particularly demonstrated its non-inferior efficacy and safety compared with TURP, shorter catheterization and hospital stay and long-term efficacy. 15,16 Despite growing evidence on efficacy and efficiency regarding these laser treatments, data comparing GreenLight laser PVP and ThuVEP are lacking, and to our best knowledge, there is only one direct comparison available in the literature. 17 Prospective, single surgeon, randomized controlled trial, is theoretically the best level of evidence in evidence-based medicine, but this is not always made possible in a "real-life" setting; 18 thus, the aim of this study is to compare data on efficacy and safety of patients undergoing in a daily practice standard 180 Watt GreenLight laser PVP as compared to ThuVEP. ...
Article
Objectives: To compare in daily practice efficacy and safety of standard 180-Watt GreenLight laser photo-selective vaporization (PVP) and Thulium laser Vaporesection of the prostate (ThuVEP). Material: All men were evaluated with prostate volume (PV), PSA, International Prostate Symptom Score (IPSS) and maximum urinary flow (Qmax). Patient Global Impression of Improvement (PGI-I) was evaluated with PGI-I scale at 6-months. Antiplatelet/anticoagulant therapy, operation time, 24-hours hemoglobin drop (ΔHb), length of catheterization, discharge day, early complications and reoperation after 30-days were gathered. Differences between interventions were estimated using propensity scores to adjust for different patients characteristics. The propensity scores were estimated by fitting a stepwise logistic regression model with intervention type as the dependent variable and all the covariates. Results: 505 men underwent the surgical procedures (291 PVP and 214 ThuVEP). Mean age was 69.6 years. Mean PV was 54 ml. Median operation time was 55 minutes. Median catheterization time was 2 days in both series. After matching, the postoperative stay was similar in both groups (2 days). ΔHb at 24h was statistically significantly lower in PVP (-0.5 vs. -0.8 g/dl, p 0.002). Most of the complications were mild-to-moderate and comparable among groups. ΔQmax was similar at 6-month before and after matching, whereas PVP group had a better improvement at 12-month. 96.4% of all patients had an improvement of their symptoms, with no difference between groups, before and after matching. Conclusion: Our study demonstrated that PVP and ThuVEP are similar in term of complications and outcomes, with high patients' satisfaction.
... This may be due to a lower threshold for transfusion in the older patient population of this study (mean age: ThuVEP 76; TURP 72). There was minimal change in hemoglobin level before and after the operation (ThuVEP: 0.5 ± 1.3 g/dl; TURP: 0.5 ± 1.1 g/dl) [Chang et al. 2015]. Because operative time was not reported and baseline patient characteristics are very different to those in the previous studies, it is difficult to make a conclusion in regard to the benefit of the higher power laser compared with the 50W laser used by Xia and colleagues in 2008. ...
Article
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In 2005, the high power thulium laser was introduced for the surgical treatment of benign prostatic obstruction. It has several properties that confer theoretical advantages over other lasers used for the same indication, such as technical versatility and a relatively small zone of thermal damage. Studies using the 70–150 W thulium laser systems demonstrate good efficacy of these procedures with low morbidity and few complications even in higher risk patients. Different techniques have been employed to treat the prostate with this technology, including enucleation, vapoenucleation, vaporization and resection. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP and holmium laser enucleation of prostate (HoLEP). In this review we discuss the current literature on the safety and efficacy of various thulium techniques for the treatment of benign prostatic hyperplasia and examine comparative studies.
... Using 2-mm continuous wave emitting end-firing fibers, the procedure was carried out as described previously. 3 After the resectoscope was placed in the urethra at the distal resection border close to the prostatic apex, careful mechanical incisions from the bladder neck were carried out at 5 o'clock and 7 o'clock directions toward the verumontanum. A third incision was then made from the bladder neck to the level of verumontanum in the 12 o'clock direction, and the separated median lobe was enucleated. ...
Article
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Purpose: To analyze the outcomes of thulium vapoenucleation of the prostate (ThuVEP) in the management of benign prostatic hyperplasia. The outcomes of this increasingly popular procedure are yet to be confirmed in patients with various prostate sizes and health status. Materials and methods: Three hundred and three patients who underwent ThuVEP were included and stratified in subgroups according to prostate size and age. We analyzed patient demographics, preoperative disease-related parameters, and perioperative and follow-up results. Correlation of prostate size and operation time were also assessed. Results: Baseline mean prostate volume was 61.0 mL (range 19.3–226 mL), mean urinary peak flow rate (Qmax) was 8.6 mL/second (range 1.4–23.25 mL/second), mean postvoid residual volume was 126.2 mL (range 0–649 mL) and mean International Prostate Symptom Score was 25.1 (range 8–35). The mean operation time was 84.0 minutes and 88.6 minutes for total and prostate volume >80 mL, respectively. After laser surgery, there were mean reductions of 5.3 ng/mL, 7.5 ng/mL, 3.7 ng/mL, and 3.5 ng/mL (38.0%, 49.7%, 30.3%, and 36.5% change from baseline) in prostate-specific antigen level among the four groups. As for postvoid residual volume, there was a significant reduction in volume in the total, prostate volume >80 mL and prostate volume
... There are several types of lasers that are used in treatment of enlarged prostate, and include holium, thulium, or greenlight lasers (39)(40)(41). The most investigated laser procedure for BPH surgery is holium laser. ...
Article
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The field of urology continues to evolve. There have been several major breakthroughs in the diagnosis and management of many urological diseases over last few decades. Just to mention the development of endourology, a subspecialty which not only does encompass visualisation of the upper and lower urinary tract but also modern management of diseases of the prostate. Other examples include ever growing field of laparoscopy or robotic urology itself to mention but the few. Moreover, there has been a significant progress with regards to improvement of existing and development of new imaging modalities including magnetic resonance imaging which has advanced from being a standard anatomical imaging modality to one providing vital functional information about the cellularity of solid tissues (diffusion weighted imaging), perfusion parameters in neoplasms (dynamic contrast imaging), and relative concentration of intracellular metabolites (spectroscopy). Furthermore, recent advances in cancer genetics and genomics have changed our management paradigms in major urologic malignancies and have led to the development of new markers for detection, prognostication, and tailoring the most effective therapy in patients with cancers of the urinary tract. This review discusses the recent advances in diagnosis and management of prostate, bladder, and renal cancers, as well as benign prostatic hyperplasia and urolithiasis.