Skip to main content
Top
Published in: BMC Surgery 1/2012

Open Access 01-11-2012 | Research article

Efficacy and safety profile of a novel technique, ThuLEP (Thulium laser enucleation of the prostate) for the treatment of benign prostate hypertrophy. Our experience on 148 patients

Authors: Fabrizio Iacono, Domenico Prezioso, Giovanni Di Lauro, Giuseppe Romeo, Antonio Ruffo, Ester Illiano, Bruno Amato

Published in: BMC Surgery | Special Issue 1/2012

Login to get access

Abstract

Background

Over the past years laser technology has played a predominant role in prostate surgery, for the treatment of benign prostate hypertrophy (BPH). Various laser devices have been introduced in clinical practice, showing good results in terms of complications and urodynamic outcomes efficacy compared with TURP and Open Prostatectomy.
In this study we describe the efficacy and the safety profile of a novel laser technique, ThuLEP (Thulium Laser Enucleation of Prostate) that permits a complete anatomical endoscopic enucleation of prostatic adenoma independently to prostate size.

Methods

148 patients with a mean age of 68.2 years were enrolled between September 2009 and March 2012 (36 months), and treated for BPH with ThuLEP. Every patient was evaluated at base line according to: Digital Rectal Examination (DRE), prostate volume, Post-Voided volume (PVR), International Prostate Symptoms Score (I-PSS), International Index of Erectile Function-5 (IIEF-5), Quality of Life (QoL), PSA values, urine analysis and urine culture, uroflowmetry. The same evaluation was conducted after a 12 month follow-up. ThuLEP was performed by 2 expert surgeons.

Results

Our data showed a better post-operative outcome in terms of catheter removal, blood loss, TURP syndrome, clot retention and residual tissue compared to large series of TURP and OP. Only 1.3% of patients had bladder wall injury during morcellation. I-PSS, Qmax, Prostate Volume, QoL and PVR showed a highly significant improvement at 12 month follow-up in comparison to preoperative assessment.

Conclusion

ThuLEP represent an innovative option in patients with BPH. It is a size independent surgical endoscopic technique and it can be considered the real alternative, at this time, to TURP and even more to Open Prostatectomy for large prostate, with a complete removal of adenoma and with a low complication rate.
Literature
1.
go back to reference Kuntz RM: Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). Eur Urol. 2006, 49: 961-9. 10.1016/j.eururo.2006.03.028.CrossRefPubMed Kuntz RM: Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). Eur Urol. 2006, 49: 961-9. 10.1016/j.eururo.2006.03.028.CrossRefPubMed
2.
go back to reference Ahyai SA, Gilling P, Kaplan SA, et al: Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010, 58: 3-84. 10.1016/j.eururo.2010.03.043.CrossRef Ahyai SA, Gilling P, Kaplan SA, et al: Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010, 58: 3-84. 10.1016/j.eururo.2010.03.043.CrossRef
3.
go back to reference Shanberg AM, Lee IS, Tansey LA, et al: Extensive neodymium-YAG photoirradiation of the prostate in men with obstructive prostatism. Urology. 1994, 43 (4): 467-71. 10.1016/0090-4295(94)90233-X.CrossRefPubMed Shanberg AM, Lee IS, Tansey LA, et al: Extensive neodymium-YAG photoirradiation of the prostate in men with obstructive prostatism. Urology. 1994, 43 (4): 467-71. 10.1016/0090-4295(94)90233-X.CrossRefPubMed
4.
go back to reference Muschter R: Laser therapy for benign prostate hyperplasia. Aktuelle Urol. 2008, 39 (5): 359-68. 10.1055/s-2008-1038267.CrossRefPubMed Muschter R: Laser therapy for benign prostate hyperplasia. Aktuelle Urol. 2008, 39 (5): 359-68. 10.1055/s-2008-1038267.CrossRefPubMed
5.
go back to reference Reich O, Gratzke C, Bachmann A, et al: Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. Urology Section of the Bavarian Working Group for Quality Assurance. J Urol. 2008, 180: 246-10.1016/j.juro.2008.03.058.CrossRefPubMed Reich O, Gratzke C, Bachmann A, et al: Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. Urology Section of the Bavarian Working Group for Quality Assurance. J Urol. 2008, 180: 246-10.1016/j.juro.2008.03.058.CrossRefPubMed
6.
go back to reference Herrmann Thomas RW, Bach T, et al: Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol. 2010, 28: 45-51. 10.1007/s00345-009-0503-0.CrossRefPubMed Herrmann Thomas RW, Bach T, et al: Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol. 2010, 28: 45-51. 10.1007/s00345-009-0503-0.CrossRefPubMed
7.
go back to reference Fried NM, Murray KE: High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol. 2005, 19 (1): 25-31. 10.1089/end.2005.19.25.CrossRefPubMed Fried NM, Murray KE: High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol. 2005, 19 (1): 25-31. 10.1089/end.2005.19.25.CrossRefPubMed
8.
go back to reference Bach T, Herrmann TR, Cellarius C, Gross AJ: Bladder neck incision using a 70 W 2 micron continuous wave laser (RevoLix). World J Urol. 2007, 25 (3): 263-267. 10.1007/s00345-007-0169-4.CrossRefPubMed Bach T, Herrmann TR, Cellarius C, Gross AJ: Bladder neck incision using a 70 W 2 micron continuous wave laser (RevoLix). World J Urol. 2007, 25 (3): 263-267. 10.1007/s00345-007-0169-4.CrossRefPubMed
9.
go back to reference Xia SJ, Zhuo J, Sun XW, et al: Thulium laser versus standard transurethral resection of the prostate: a randomised prospective trial. Eur Urol. 2008, 53 (2): 382-9. 10.1016/j.eururo.2007.05.019.CrossRefPubMed Xia SJ, Zhuo J, Sun XW, et al: Thulium laser versus standard transurethral resection of the prostate: a randomised prospective trial. Eur Urol. 2008, 53 (2): 382-9. 10.1016/j.eururo.2007.05.019.CrossRefPubMed
10.
go back to reference Fu WJ, Zhang X, Yang Y, et al: Comparison of 2-μm continuous wave laser vaporesection of the prostate and transurethral resection of the prostate: a prospective nonrandomised trial with 1-year follow-up. Urology. 2010, 75 (1): 194-9. 10.1016/j.urology.2009.07.1266.CrossRefPubMed Fu WJ, Zhang X, Yang Y, et al: Comparison of 2-μm continuous wave laser vaporesection of the prostate and transurethral resection of the prostate: a prospective nonrandomised trial with 1-year follow-up. Urology. 2010, 75 (1): 194-9. 10.1016/j.urology.2009.07.1266.CrossRefPubMed
11.
go back to reference McConnel JD, Barry MJ, Bruskewitz RC, et al: Benign prostatic hyperplasia: diagnosis and treatment. Clinical Practice Guideline. 1994, US: Department of Health and Human Services, Public Health Service, Agency for HealthCare policy and research, 8: Chap. 10-14 McConnel JD, Barry MJ, Bruskewitz RC, et al: Benign prostatic hyperplasia: diagnosis and treatment. Clinical Practice Guideline. 1994, US: Department of Health and Human Services, Public Health Service, Agency for HealthCare policy and research, 8: Chap. 10-14
12.
go back to reference Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG, Urology Section of the Bavarian Working Group for Quality Assurance: Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008, 180 (1): 246-249. 10.1016/j.juro.2008.03.058.CrossRefPubMed Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG, Urology Section of the Bavarian Working Group for Quality Assurance: Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008, 180 (1): 246-249. 10.1016/j.juro.2008.03.058.CrossRefPubMed
13.
go back to reference Serretta V, Morgia G, Fondacaro L, Curto G, Lo Bianco A, Pirritano D, et al: Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology. 2002, 60: 623-627. 10.1016/S0090-4295(02)01860-5.CrossRefPubMed Serretta V, Morgia G, Fondacaro L, Curto G, Lo Bianco A, Pirritano D, et al: Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology. 2002, 60: 623-627. 10.1016/S0090-4295(02)01860-5.CrossRefPubMed
14.
go back to reference Mearini E, Marzi M, Mearini L, Zucchi A, Porena M: Open prostatectomy in benign prostatic hyperplasia: 10-year experience in Italy. Eur Urol. 1998, 34: 480-485. 10.1159/000019787.CrossRefPubMed Mearini E, Marzi M, Mearini L, Zucchi A, Porena M: Open prostatectomy in benign prostatic hyperplasia: 10-year experience in Italy. Eur Urol. 1998, 34: 480-485. 10.1159/000019787.CrossRefPubMed
15.
go back to reference Liedberg F, Adell L, Hagberg G, Palmqvist IB: Interstitial laser coagulation versus transurethral resection of the prostate for benign prostatic enlargement—a prospective randomized study. Scand J Urol Nephrol. 2003, 37: 494-7. 10.1080/00365590310001773.CrossRefPubMed Liedberg F, Adell L, Hagberg G, Palmqvist IB: Interstitial laser coagulation versus transurethral resection of the prostate for benign prostatic enlargement—a prospective randomized study. Scand J Urol Nephrol. 2003, 37: 494-7. 10.1080/00365590310001773.CrossRefPubMed
16.
go back to reference Montorsi F, Naspro R, Salonia A, et al: Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004, 172: 1926-9. 10.1097/01.ju.0000140501.68841.a1.CrossRefPubMed Montorsi F, Naspro R, Salonia A, et al: Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004, 172: 1926-9. 10.1097/01.ju.0000140501.68841.a1.CrossRefPubMed
17.
go back to reference Imkamp F, Bach T, Gross AJ, Kuczyk MA, Herrmann TR: ThuLEP—Thulium laser enucleation of the prostate. J Endourol. 2009, 23 (Suppl 1): 24- Imkamp F, Bach T, Gross AJ, Kuczyk MA, Herrmann TR: ThuLEP—Thulium laser enucleation of the prostate. J Endourol. 2009, 23 (Suppl 1): 24-
18.
go back to reference Van Melick HH, van Venrooij GE, Boon TA: Long-term follow-up after transurethral resection of the prostate, contact laser prostatectomy, and electrovaporization. Urology. 2003, 62: 1029-34. 10.1016/S0090-4295(03)00769-6.CrossRefPubMed Van Melick HH, van Venrooij GE, Boon TA: Long-term follow-up after transurethral resection of the prostate, contact laser prostatectomy, and electrovaporization. Urology. 2003, 62: 1029-34. 10.1016/S0090-4295(03)00769-6.CrossRefPubMed
19.
go back to reference Wendt-Nordahl G, Huckele S, Honeck P, Alken P, Knoll T, Michel MS, Häcker A: Systemic evaluation of a recently introduced 2-micron contiuous-wave laser for vaporesection of theprostate. J Endourol. 2008, 22: 1041-1045. 10.1089/end.2007.0421.CrossRefPubMed Wendt-Nordahl G, Huckele S, Honeck P, Alken P, Knoll T, Michel MS, Häcker A: Systemic evaluation of a recently introduced 2-micron contiuous-wave laser for vaporesection of theprostate. J Endourol. 2008, 22: 1041-1045. 10.1089/end.2007.0421.CrossRefPubMed
20.
go back to reference Bach T, et al: 70 vs 120 W thulium:yttrium – aluminium – garnet 2 micron continuous-wave laser for the treatment of benign prostatic hyperplasia: a systematic ex vivo evaluation. B JU Int. 2010, 106: 368-72. 10.1111/j.1464-410X.2009.09059.x. Bach T, et al: 70 vs 120 W thulium:yttrium – aluminium – garnet 2 micron continuous-wave laser for the treatment of benign prostatic hyperplasia: a systematic ex vivo evaluation. B JU Int. 2010, 106: 368-72. 10.1111/j.1464-410X.2009.09059.x.
Metadata
Title
Efficacy and safety profile of a novel technique, ThuLEP (Thulium laser enucleation of the prostate) for the treatment of benign prostate hypertrophy. Our experience on 148 patients
Authors
Fabrizio Iacono
Domenico Prezioso
Giovanni Di Lauro
Giuseppe Romeo
Antonio Ruffo
Ester Illiano
Bruno Amato
Publication date
01-11-2012
Publisher
BioMed Central
Published in
BMC Surgery / Issue Special Issue 1/2012
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/1471-2482-12-S1-S21

Other articles of this Special Issue 1/2012

BMC Surgery 1/2012 Go to the issue