3 articles
Specialists are currently interested in the method of choice for surgical treatment in patients with enlarged benign prostate hyperplasia (> 80 cm3). The introduction of laser and bipolar technologies for benign prostate hyperplasia surgery has allowed effective treatment regardless of the size of the prostate gland.
During 2020-2021, 65 patients underwent surgical treatment for large benign prostate hyperplasia. Depending on the type of surgical treatment performed, 3 study groups were identified: 22 patients underwent transurethral Thulium:YAG laser prostate vapoenucleation; 21 patients underwent transurethral bipolar prostate enucleation; and 21 patients underwent a simple prostatectomy. All patients were examined before and after surgery (at 3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score, prostate-specific antigen assessment, transrectal prostate ultrasound examination, and uroflowmetry to assess residual urine volume. Postoperative complications were recorded in accordance with the 2004 Clavien-Dindo classification.
There was a significant difference in the mean operative time ranging from 72±19 min (ThuVEP group) vs. 56±10 min (SP group) and 70±15 min (TUEB group), as well as a decrease in hemoglobin levels, viz. 1.2±0.4 g/dl vs. 2.6±1.1 g/dl vs. 1.6±0.5 g/dl (ThuVEP vs. SP vs. TUEB). The catheterization lasted for 2±1 days (ThuVEP) vs. 10±1 days (SP) vs. 3±1 days (TUEB). A significant improvement in Qmax was registered in the ThuVEP group (122.9%) and in the TUEB group (111.7%). However, patients after a simple prostatectomy showed an increase in Qmax of only 94%. The PVR values were reported to be the same. ThuVEP is an effective surgical technique for large BPH patients. The reduced trauma and lower complication rate of ThuVEP, as well as its effectiveness, have confirmed the need for widespread implementation of minimally invasive laser interventions.
The advantages of ThuVEP compared to TUEB and especially to SP are obvious. Thus, the maximum improvement in PVR was obtained in the ThuVEP group and amounted to 84.6%. The Qmax values in this group of patients also showed an excellent +122% increase. Considering the similar postoperative urodynamic results obtained after all types of surgical interventions, which were assessed within the present research (ThuVEP, TUEB, and SP), as well as a significantly lower complication rate (14.27%) found in the ThuVEP group, we consider it rational to use Thulium:YAG laser energy in the treatment of large BPH.
According to the current recommendations of the European Association of Urology and the International Society of Urology, open simple prostatectomy is the reference standard in the surgical treatment of benign prostatic hyperplasia of large size (>80 ml). Extended trauma and a high complication rate reduce the chances to use this method. In this context, several minimally invasive laser surgical treatment techniques have been proposed in order to provide an optimal treatment to patients. Transurethral endoscopic vapoenucleation of the prostate using laser energy is a new concept in endourological surgery.
Between September 2019 and December 2019, 93 patients with benign prostatic hyperplasia underwent surgical treatment. Two surgical methods were applied: transurethral Thulium:YAG laser prostate vapoenucleation (45 patients) and open simple prostatectomy (48 patients). All patients were evaluated preoperatively and postoperatively (3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score and International Erectile Function Index, physical examination and digital rectal examination, prostate specific antigen assessment, transrectal prostate ultrasound examination and assessment of residual urine volume, uroflowmetry. Postoperative complications were recorded according to the Clavien-Dindo classification, 2004. The inclusion criteria were total prostate volume ≥80 cm3, age ≤80 years, residual urine volume ≥70 ml, Qmax ≤10 ml/s.
Transurethral Thulium:YAG laser vaponucleation of prostate has proven a high surgical efficiency level. The baseline urodynamic and ultrasonographic indicators after transurethral vapoenucleation at 6 months postoperatively were similar to those in the control group (open simple prostatectomy). The duration of recovery of patients after classical surgery was significantly longer. At the same time, the rate of postoperative complications after prostate vapoenucleation was lower. Patients in the ThuVEP group did not require blood transfusions.
According to obtained results, we can assume that transurethral vapoenucleation of the prostate with laser energy will soon become a new „gold standard” in the surgical treatment of large benign prostate hyperplasia.
The current treatment for primary NMIBC is the transurethral resection of bladder tumor (TURBT) which is combined with postoperative intravesical instillation. It has been proven that the rate of disease recurrence depends on the quality of the primary surgical operation. Due to the development of laser surgery, the appearance of holmium (Ho:YAG) and later, in the 1990s, the appearance of thulium (Tm:YAG) lasers, the en-bloc laser resection was possible. The aim of this research was to compare results after Thulium laser En-bloc transurethral resection and transurethral resection of non-muscular invasive urinary bladder tumors.
Between February 2017 and May 2019, within the Urology Clinic of Nicolae Testemițanu State University of Medicine and Pharmacy 65 patients with bladder tumor pathology were surgically treated. Patients were divided in two groups: Thulium laser En-bloc transurethral resection group which includes 32 patients and transurethral resection group with 33 patients. The obtained data were comparatively analyzed.
Tumor analysis showed that in most of the cases tumors were localized on the lateral walls of the bladder, a tumor up to 3 cm in size was detected in 71% of cases (46 patients) and single bladder tumors were detected in 65% of cases (42 patients) included in the study. Detrusor muscle was detected in 73% of cases in the TURBT group and in 97% of cases in the TmLRBT group. The majority of recurrences during the 12-month follow-up occurred in the TURBT group 39% (13 cases) in initial resection area 54% (7 cases). For TmLRBT group recurrence rate was 15% (5 cases), recurrence occurred predominantly in the non-primary resection area 80% (4 cases).
The Thulium laser En-bloc transurethral resection of non-muscle-invasive bladder tumor (TmLRBT) proved to be an effective and safe method of treatment compared to the conventional transurethral resection (TURBT). This technique allows the obtaining of tumor samples in a higher quality (detrusor muscle is present in more cases), contributing to a correct diagnosis and staging of the disease. Finally, it leads to more favorable results and a reduction of recurrence rate.