Figure 3 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
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.
Source publication
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...
Citations
... Operative time and hospital duration were also equivalent, but ThuLEP was associated with slightly lower blood loss and lower rates of transient incontinence than HoLEP [72]. ThuVEP has a smaller evidence base consisting predominately of prospective single-centre case series with Chang et al. reporting significant improvements in IPSS and Q max from baseline to 12 months with an overall complication rate of 20.7% [73]. ...
The management of benign prostatic obstruction (BPO) should involve a treatment algorithm that takes into account prostate size, and patient’s symptoms and preference with the aim of helping with urinary symptoms and enhance quality of life. The diagnostic assessment for men with lower urinary tract symptoms (LUTS) should be comprehensive to help choose the best management strategy. Strategies from lifestyle modifications to medical treatment with alpha blockers and/or 5-alpha-reductase inhibitors to surgical procedures can all be used in the management algorithm. Surgical management ranges from transurethral resection of prostate (TURP) to minimally invasive surgical therapies (MIST) including laser therapies such as Holmium laser enucleation (HoLEP) and photoselective vaporisation (PVP), aquablation, Rezūm system, prostate artery embolisation (PAE), prostatic urethral lift (PUL), temporary implantable nitinol device (iTind) and Optilume BPH catheter system. BPO is a common urological condition that has a significant impact on quality of life and economic burden globally and is likely to become increasingly prevalent with an ageing population. Selecting the most appropriate treatment modality will depend on the individual patient preferences, availability of resources, cost, anatomical factors and the goals of treatment.
... In a prospective study, Chang et al compared the use of ThuVEP versus TURP in patients >70 years. 19 Most baseline characteristics of both groups were similar; however, the ThuVEP group consisted of 29 men with a mean age of 76.1 while the TURP group consisted of 30 men with a mean age of 72.6. Post-operatively, the ThuVEP group experienced a shorter catheterization time and hospital stay. ...
... Clinical Interventions in Aging 2023 :18 invasive option that can be performed in an office setting using local anesthesia. 2,3,19,[26][27][28][29][30] The prostatic urethral lift can preserve sexual function and can also be performed in-office, though limitations include prostate size and may be challenging with a middle lobe. 2,31 For medically complex patients with higher bleeding risk, the AUA suggests the use of procedures such as HoLEP, ThuLEP, Greenlight, and ThuVEP, as they have shown promising improvement in functional urinary outcomes in the elderly and avoid the morbidity of simple prostatectomy. ...
Objective
We set out to review studies reporting on the use of surgical intervention to treat Benign Prostatic Hyperplasia in elderly men ≥70 years of age.
Methods
A systematic literature search was conducted using Scopus, PubMed-MEDLINE, Cochrane, and Wiley Online Library databases including studies published between January 2012 through December 2022. This 10-year interval was chosen given the recent plethora of new modalities that have entered the BPH armamentarium, many of which have been marketed as appropriate for older and high-risk patients. The following database search words were used either individually or in conjunction: “BPH”, “elderly”, “surgical”, “ablation”, “resection”, “embolization”, and “aging”.
Results
We identified 28 studies for inclusion in this review. The pros and cons of these modalities are presented, specifically as applicable to an older and higher risk population.
Conclusion
There are a wide variety of surgical procedures available for surgically treating BPH in elderly men with varying states of health. Each of these comes with different risks and benefits, supporting that individualized approaches are important. Long-term data and further studies comparing modalities, specifically as regards the elderly and frail, would enhance our approaches to BPH treatment in this patient population.
... ThuLEP is rapidly becoming recognized as a safe and efficient method for treating BPH [7]. Most previous research assessed the effectiveness and viability of using high-power ThuLEP (120-200 W) for large prostates [8,9,10]. In 2021 Omar et al. [11] published a study that evaluated the utilization of low-power ThuLEP. ...
... This incident can occur due to injury from the sphincter and mucosa because it requires a good learning curve in operating the laser procedure, in other hands the deepest penetration of laser may lead to damage the tissue. 30,34 Dysuria in our meta-analysis produced significant results in the laser group because tissue trauma and the remaining necrotic and coagulated tissue caused inflammation symptoms [35][36][37] Weaknesses in our first study were that HoLEP vs TURP had more proportions compared to ThuLEP, DiLEP compared to TURP. Both of us did not have enough data at follow up for more than 12 months. ...
Introduction
and objectives: Laser anatomical endoscopic enucleation of the prostate (LAEEP) is one of the alternative surgical procedures other than TURP for benign prostate hyperplasia (BPH). However, the consideration for clinical practice needs evidence in terms of efficacy and safety. Our meta-analysis based on the existing studies is to evaluate the efficacy and safety of the LAEEP and TURP for BPH treatment.
Materials and methods
Published randomized controlled trials (RCTs) were identified from PubMed, Science Direct, and Cochrane Library up to December 2021. The meta-analysis was performed by the requirements of PRISMA and after methodological quality assessment, the data was proceeded by RevMan V.5.4.
Results
15 studies were identified with total of 733 patients who underwent LAEEP and 698 patients underwent TURP. There was no significant difference in IPSS at 1,3,6 month but at 12 months significantly better in LAEEP (MD = −0.43 [-0.81, −0.05] P = 0.03). At 6 and 12 months, the PVR data showed significantly lower in LAEEP (MD = −4.07 [-6.07, −2.07] P < 0.0001). QoL, Qmax, and IIEF-5 scores were no significant difference in both procedures. Duration of catheterization (MD = −25.01 [-30.47, −19.55] P = 0.00001) and hospital stay (MD = −30.26 [-40.71, −19.82] P = 0,00001) were significantly shorter in LAEEP. Operative duration was significantly shorter in TURP (MD = 14.69 [8.64, 20.75] P = 0.00001) but prostate specimen weight result was significantly higher in LAEEP procedure (MD = 4.77 [0.36, 9.17] P = 0.03). Hb drop level (MD = −0.58 [-0.85, −0.30] P = 0.0001), transfusion rate (OR = 0.37 [0.17, 0.84] P = 0.02) and UTI (OR = 0.35 [0.17, 0.71] P = 0.004) were significantly fewer in LAEEP. However, dysuria events less occurred in TURP (OR = 2.45 [1.51, 3.97] P = 0.0003).
Conclusion
Compared with TURP, LAEEP showed better efficacy and safety with fewer hematological changes and complications, except for operative duration, dysuria events were better in TURP. LAEEP showed other advantages in shorter catheterization time and hospital stay.
... 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. ...
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. ...
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. ...
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].
... Aceste date sunt menționate întru-un șir de publicații recent apărute. Datele prezentate de către Chang au demonstrat ratele totale de complicații de 20,7% vs 30% (Thu-VEP vs TURP), ceea ce dovedește siguranța acestei metode [8]. Concomitent cu siguranța operatorie, este asigurată și eficiența procedeului chirurgical. ...
Laser prostate surgery is currently considered as being an alternative to other surgical approaches like mono or bipolar transurethral resection and classical open surgery. The implementation of transurethral Thulium: YAG laser vapoenucleation of the prostate opens up new avenues in the treatment of benign prostatic hyperplasia. Therefore, the use of Th uVEP and the subsequent fragmentation of vapoenucleated adenomatous nodules may completely change the surgical approach in the treatment of benign prostatic hyperplasia. The study included 23 patients with benign prostatic hyperplasia, who underwent minim invasive surgical treatment via transurethral Thulium: YAG laser vapoenucleation within the Urology Clinic of „Nicolae Testemitanu” SUMPh. The patients tolerated the surgical procedure well. Patients, with mean age of 62.4±3 years, were assessed at 3, 6, and 12 months aft er the surgery. A constant improvement of the IPSS and QoL scores was determined. A 15-point IPSS and 2-point Qol decrease was registered. No signifi cant decrease in IIFE-5 score was reported. The highest Qmax and Qmean increase was registered at 12 months: 150% and 139.4% respectively. The mean urine output increased to 59ml or 47.9%. The mean prostate volume decreased to 41±5cm3 (-4.1%), whereas the volume of residual urine showed a decrease of about 66±18ml (-77%). Given the excellent effi cacy of minimally invasive ThuVEP, it might be recommended as a surgical method of choice in the treatment of benign prostatic hyperplasia.
... 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 . ...
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.
... No significant difference found in complication rate. Chang et al. [12] A total of 29 patients were assigned to have ThuVEP and 30 to TURP. Voided volume, Qmax, PVR and mean flow rate all improved significantly in both groups and there were no differences in IPSS or QoL after 1 year of follow up. ...
