Feasibility and efficacy of Thulium:YAG laser enucleation (VapoEnucleation) of the prostate

Thulium:YAG (Tm:YAG) vaporesection has been introduced and efficiency was shown on smaller prostates. Criticism mainly referred to prolonged operation time in larger prostates, which appears to be a potential limitation compared to HoLEP. Aim of the study was to evaluate feasibility and efficiency of Tm:YAG VapoEnucleation in larger prostates.

VapoEnucleation was performed using a 70 W continuous wave-laser. After enucleation tissue was morcellated within the bladder. Prospectively assessed outcomes were improvement in urodynamic parameter and the intra- and postoperative course. Complications were recorded.

A total of 88 consecutive patients with prostatic enlargement underwent VapoEnucleation. Prostatic volume was 61.3 ± 24.0 cc (30–160). OR-time was 72 min ± 26.6 (35–144) and laser-time 32.4 ± 10.1 min (16.3–59.3). Applied laser energy was 123.7 ± 40.6 kJ (67.8–240.9). An average of 31.7 ± 18.3 g of tissue was retrieved. Pathology revealed four patients with incidental carcinoma. Foley catheter-time was 2 days and the suprapubic tube, if placed, was removed on the third postoperative day on average. Twelve complications were recorded, including bleeding (3), urinary tract infection (6), second-look procedure, due to insufficient deobstruction (2). Re-catherization after successful initial voiding trial was necessary in one patient. Mean peak flow rate improved from 3.5 ± 4.7 to 19.8 ± 11.6 ml/s and post-voiding residual urine decreased from 121.4 ± 339.9 to 22.4 ± 32.7 ml.

The functional outcomes demonstrate efficiency of Tm:YAG VapoEnucleation for patients with larger prostates. From our experience, learning curve in VapoEnucleation is short and complications are minimal. Theoretically, no limitation in prostate size occurs. Long-term follow-up is needed to prove durability.