Objective:To compare the efficacy and safety of transurethral thulium laser enucleation of prostate for benign prostatic hyperplasia (BPH) with laser controller and sheath.Methods:The clinical data of 128 BPH patients who underwent transurethral thulium laser enucleation of prostate (THuLEP) in our hospital from January to June 2020 were retrospectively analyzed. Prostatic enucleation by laser controller was performed in 66 patients (LC-THuLEP group). The prostatic urethral mucosa was cut into Ω shape at 0.5 cm in front of the verumontanum to expose the prostate capsule, and then the fiber was retracted into the laser controller. Push the gland directly between the prostate gland and the prostate surgical capsule and expand along the capsule by the laser controller. In case of bleeding or prostate adhesive cord, the fiber was extended to coagulate or cut off, and the prostate was eventually en bloc removed. THuLEP by sheath was performed in 62 cases (THuLEP group). The ages of patients in LC-THuLEP group and THuLEP group were (71.00±8.72) years and (70.32±7.80) years, respectively. The prostate volumes were (74.80±40.88) ml and (73.14±36.31) ml, respectively. Prostate specific antigen (PSA) was (4.67±4.99) ng/ml and (4.89±4.59) ng/ml, International Prostate Symptom Score (IPSS) was (19.48±5.30) points and (18.50±5.05) points, respectively. The quality of life (QOL) scores were (4.17 ± 0.78) points and (4.18± 0.67) points, the maximum urine flow rate (Q max) was (9.82± 2.58) ml /s and (9.98± 2.91) ml/s, respectively. Postvoid residual (PVR) was (60.20±39.19) ml and (61.11±52.83) ml, respectively. The international index of erectile function (IIEF-5) score was (5.58±4.50) and (5.60±4.16), respectively.There was no significant difference in preoperative baseline data between 2 groups ( P>0.05). The operation time, the reduced level of hemoglobin, the weight of removed tissue, The time to postoperative bladder irrigation, the time to indwelling catheter and complications were compared between the two groups. IPSS, QOL score, Q max, PVR, and complications were compared between the two groups at 1, 3 and 6 months after surgery, while IIEF-5 score were compared only at 6 months after surgery. Results:The operative time of LC-THuLEP group and THuLEP group was (71.85±25.68) min and (80.65±29.64) min, respectively, and the decrease of postoperative hemoglobin was (6.42±9.89) g/L and (9.47±10.79) g/L, respectively, the weight of the removed tissue was (56.73±31.21) g and (48.11±24.50) g, respectively, and the time to postoperative bladder irrigation was (14.73±2.71) h and (16.06±2.71) h, respectively, the time to indwelling catheter was (4.41±1.92)d and (4.31±1.66)d, respectively, with no statistically significant differences between the two groups. IPSS scores of LC-THuLEP group were (6.52±2.46) points, (5.83±2.43) points and (5.30±2.49) points at 1, 3 and 6 months after surgery, respectively. QOL scores were (2.36±0.85) points, (2.27±1.02) points and (1.98±0.77) points, Q max were (22.89±2.41) ml/s, (23.61±2.62) ml/s and (23.83±3.53) ml/s, respectively. In THuLEP group, IPSS were (7.60±1.89) points, (6.86±1.81) points and (6.44±1.78) points at 1, 3 and 6 months after surgery, and QOL scores were (2.68±0.67) points, (2.74±1.01) points and (2.35±0.68) points, respectively. Q max were (21.31±2.52) ml/s, (22.13±2.51) ml/s and (22.11±2.49) ml/s, respectively. Those indexes (except Qmax at 6 months)were better in LC-ThuLEP group than THuLEP group, and the differences were statistically significant ( P<0.05). PVR of LC-THuLEP group were (15.95±12.31) ml, (14.83±12.19) ml and (13.67±15.03) ml, respectively, PVR of THuLEP group were (21.89±21.14) ml, (20.03±21.51) ml and (19.69±21.19) ml, respectively, and there were no significant differences. There was no bladder injury, severe bleeding, blood transfusion or secondary operation. The incidence of urinary incontinence 1 month after surgery was 6.1% (4/66) in the LC-THuLEP group and 19.4% (12/62) in the THuLEP group, the difference was statistically significant ( P<0.05). There was no significant difference at 3 months (3/66 vs. 4/62) and 6 months (1/66 vs. 2/62) after surgery ( P>0.05). There were no significant differences in the incidence of epididymitis, urethral stricture and bladder neck contracture between the two groups ( P>0.05). Conclusion:Compared by sheath, THuLEP by laser controller could be a safe and effective surgical method with better curative effect and lower complication rate.

Objective:To analyze the efficacy, safety and learning curve of Thulium laser enucleation of the prostate by laser controller(LC-THuLEP) anchored at six o'clock position of the bladder neck in the treatment of benign prostatic hyperplasia(BPH) with large gland.Methods:The clinical data of the 1st to 45th BPH cases with large gland(prostate volume> 80 ml) treated by a doctor with LC-THuLEP anchored at six o'clock position of bladder neck in Shanghai East Hospital from January to October 2022 were retrospectively analyzed. The patients were divided into groups A, B and C according to the order of operation time, with 15 cases in each group. There were no significant differences among the three groups( P>0.05) in age[(71.8±9.4)years old vs. (73.5±8.2) years old vs.(71.4±5.5)years old], prostate volume[88.3(84.8, 100.6)ml vs.91.5(86.1, 118.4)ml vs. 94.5(84.7, 101.8)ml], prostate specific antigen(PSA)[4.8(2.9, 8.5)ng/ml vs. 7.2(3.2, 11.2)ng/ml vs. 7.8(4.5, 12.7)ng/ml], postvoid residual volume[44.0(34.0, 67.0)ml vs. 60.0(40.0, 76.0)ml vs. 39.0(0, 59.0)ml], maximum urine flow rate(Q max)[8.4(7.6, 11.1)ml/s vs. 8.6(6.5, 10.6)ml/s vs. 10.4(7.8, 13.2)ml/s], international prostate symptom score(IPSS)[20(18, 21) vs. 20(20, 22) vs. 20(20, 25)]and quality of life(QOL)[4(4, 5) vs. 4(4, 4) vs. 4(3, 5)].The doctor had more than 100 cases of TURP surgery experience. LC-THuLEP anchored at six o'clock position of bladder neck was described as follows. The bladder neck at six o'clock position is reserved 0.5-1.0 cm as an "anchor" to fix the prostatic bladder neck when the gland was pushed directly by the laser controller, preventing the detached prostate gland from turning. Finally the bladder neck was cut off at six o'clock position, and the prostate was en-bloc removed. The effect of surgery and postoperative complications were compared. The enucleation efficiency was equal to the weight of prostate tissue removed divided by the time of enucleation. Results:The differences among the three groups in operation time [100.0(90.0, 110.0)min vs. 80.0(70.0, 90.0)min vs. 75.0(70.0, 90.0)min], enucleation time[89.0(72.0, 97.0)min vs. 67.0(64.0, 77.0)min vs. 64.0(60.0, 77.0)min] and the efficiency of enucleation [0.65(0.62, 0.68)g/min vs. 0.84(0.83, 0.94)g/min vs. 0.93(0.82, 1.00)g/min] were statistically significant( P<0.05). The operation time and enucleation time in groups B and C were significantly lower than those in group A, and the enucleation efficiency was significantly higher than that in group A( P<0.05), while there was no significant difference between group B and C. However, the difference of three groups in hemoglobin decrease [8.0(5.0, 11.0)g/L vs. 7.0(2.0, 10.0)g/L vs. 11.0(4.0, 16.0)g/L] and catheter indwelling duration[4.0(2.0, 6.0)d vs. 6.0(3.0, 7.0)d vs. 4.0(3.0, 6.0)d] were not statistically different( P>0.05). All patients were followed up for 6 months after surgery. In three groups, postoperative Q max were 23.2(21.0, 25.1)ml/s, 22.7(21.1, 26.1)ml/s and 22.9(21.5, 25.7)ml/s, IPSS were 6(5, 8), 7(6, 8) and 7(7, 8), QOL were 2(1, 2), 2(1, 2) and 2(1, 2), postvoid residual volume were 20.0(10.0, 25.0)ml, 22.0(15.0, 25.0)ml and 5.0(0, 25.0)ml, respectively, which were all significantly different from that of pre-operation( P<0.05).However, there were no statistically significant differences in the postoperative indicators among the three groups ( P>0.05). No statistical difference was found in postoperative complications among the three groups[26.7%(4/15) vs. 20.0%(3/15) vs. 20.0%(3/15), P>0.05]. Conclusions:LC-THuLEP anchored at six o'clock position of bladder neck was an effective operation in the treatment of BPH with large gland, and the learning curve could be reached after 15 cases.