BACKGROUNDThis study compared the efficacy and safety between 120-W thulium:yttrium-aluminum-garnet (Tm:YAG) vapoenucleation of prostates (ThuVEP) and holmium laser enucleation of prostates (HoLEP) for patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).

METHODSA retrospective analysis of 88 consecutive patients with symptomatic BPH was carried out, who underwent either 120-W ThuVEP or HoLEP nonrandomly. Patient demographics and peri-operative and 12-month follow-up data were analyzed with the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum flow rate (Qmax), postvoid residual urine volume (PVR), and rates of peri-operative and late complications.

RESULTSThe patients in each group showed no significant difference in preoperative parameters. Compared with the HoLEP group, patients in the 120-W ThuVEP group required significantly shorter time for laser enucleation (58.3 ± 12.8 min vs. 70.5 ± 22.3 min, P = 0.003), and resulted in a significant superiority in laser efficiency (resected prostate weight/laser enucleation time) for 120-W Tm:YAG laser compared to holmium:YAG laser (0.69 ± 0.18 vs. 0.61 ± 0.19, P = 0.048). During 1, 6, and 12 months of follow-ups, the procedures did not demonstrate a significant difference in IPSS, QoL score, Qmax, or PVR (P > 0.05). Mean peri-operative decrease of hemoglobin in the HoLEP group was similar to the ThuVEP group (17.1 ± 12.0 g/L vs. 15.2 ± 10.1 g/L, P = 0.415). Early and late incidences of complications were low and did not differ significantly between the two groups of 120-W ThuVEP and HoLEP patients (P > 0.05).

CONCLUSIONS120-W ThuVEP and HoLEP are potent, safe and efficient modalities of minimally invasive surgeries for patients with LUTS due to BPH. Compared with HoLEP, 120-W ThuVEP offers advantages of reduction of laser enucleation time and improvement of laser efficiency.

Aged ; Aluminum ; therapeutic use ; Humans ; Laser Therapy ; Male ; Middle Aged ; Prostate ; surgery ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Retrospective Studies ; Thulium ; therapeutic use ; Treatment Outcome ; Yttrium ; therapeutic use

OBJECTIVETo evaluate the effect of endourethrotomy with thulium laser as a minimally invasive treatment for urethral stricture.

METHODSWe treated 36 cases of urethral stricture or atresia by endourethrotomy with thulium laser, restored the urethral continuity by vaporization excision of the scar tissue, and observed the clinical effects and complications.

RESULTSThe mean operation time was 35 min, ranging from 10 to 90 min. Smooth urination was achieved after 2-6 weeks of catheter indwelling, with no urinary incontinence. The patients were followed up for 4-24 (mean 12) months, during which 27 did not need any reintervention, 5 developed urinary thinning but cured by urethral dilation, 3 received another laser urethrotomy for previous negligence of timely urethral dilation, and the other 1 underwent open urethroplasty.

CONCLUSIONThulium laser urethrotomy is a safe and effective minimally invasive option for short urethral stricture, which is also suitable for severe urethral stricture and urethral atresia. Its short-term outcome is satisfactory, but its long-term effect remains to be further observed.

Adult ; Humans ; Laser Therapy ; Male ; Middle Aged ; Thulium ; therapeutic use ; Treatment Outcome ; Ureteroscopy ; Urethral Stricture ; surgery ; Young Adult

OBJECTIVETo investigate and compare the effect and safety of Holmium laser and Thulium laser in transurethral enucleation of the prostate in BPH patients.

METHODSNinety-eight BPH patients were divided into 2 groups and underwent transurethral enucleation of the prostate with holmium laser (Ho group) and thulium laser (Th group) respectively. Comparisons were made between the 2 groups in operation time, bleeding volume, electrolyte, IPSS score, PVR and Qmax.

RESULTSNo statistically significant differences were noted between the 2 groups in age and preoperative prostate volume, IPSS, PVR and Qmax (P > 0.05). The mean operation time was shorter in the Th group ([84.6 +/- 10.2] min) than in the Ho group ([70.5 +/- 7.5] min) (P = 0.032); blood loss was less in the former ([126.5 +/- 14.6] ml) than in the latter ([176.5 +/- 14.1] ml) (P = 0.071), with no blood transfusion necessitated; and the mean times of catheter indwelling were 2.4 d and 2.5 d respectively. There were no significant differences in the levels of hemoglobin and electrolyte before and after operation between the two groups, and no TURP syndrome was observed. IPSS, PVR and Qmax before operation were significantly different from those obtained 3 months after it (P < 0.05) in both the groups, but none of the indexes exhibited statistically significant differences when compared in the same period (P > 0.05).

CONCLUSIONBoth holmium and thulium laser transurethral enucleation of the prostate can alleviate LUTS in BPH patients with similar short-time effectiveness. Thulium is superior to holmium laser in hemostasis, but inferior to it in anatomical distinctness.

Aged ; Aged, 80 and over ; Humans ; Lasers, Solid-State ; therapeutic use ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Thulium ; therapeutic use ; Transurethral Resection of Prostate ; methods ; Treatment Outcome

OBJECTIVETo compare the effects of greenlight photoselective vaporization prostatectomy (PVP) and thulium laser vaporesection of the prostate (TmLRP) in the treatment of aged high-risk BPH patients with the prostate weighing > 80 g.

METHODSWe included in this study 118 high-risk BPH patients aged 62-96 (mean 76) years with the prostate heavier than 80 g, 82 treated by PVP and the other 36 by TmLRP. Then we compared the operation time, intraoperative bleeding, complications, short-term effectiveness, and surgical cost between the two groups.

RESULTSAll the patients tided over the perioperative period without blood transfusion and serious complications. The mean operation time, postoperative bladder irrigation time and surgical cost were significantly less in the TmLRP than in the PVP group (P < 0.05). Both the procedures remarkably improved the international prostatic symptom score (IPSS), quality of life (QOL), post void residual urine (PVR) and Qmax of the patients (P < 0.05), but with no significant differences between the two groups (P > 0.05).

CONCLUSIONBoth PVP and TmLRP are effective and safe for the treatment of aged high-risk BPH patients with the prostate heavier than 80 g, but the latter is superior for its shorter operation time and lower surgical cost.

Aged ; Aged, 80 and over ; Humans ; Laser Therapy ; methods ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Thulium ; administration & dosage ; therapeutic use ; Transurethral Resection of Prostate ; methods ; Treatment Outcome ; Volatilization

PURPOSE: Various articles have previously addressed the introduction of new surgical laser therapies for an enlarged prostate gland causing obstructive symptoms. The objective of this study was to report the feasibility of performing the thulium laser vapo-enucleation of the prostate (ThuVEP) procedure for benign prostatic obstruction in a 1-day surgery. MATERIALS AND METHODS: From September 2011 to September 2013, we conducted a prospective study on patients who underwent ThuVEP in a 1-day surgery. The primary outcomes measured perioperatively included operative time, resected tissue weight, hemoglobin decrease, transfusion rate, postoperative irrigation and catheterization time, and postoperative hospital stay. Also, the preoperative and postoperative International Prostate Symptom Score (IPSS) and results of uroflowmetry performed on the 7th and 30th postoperative days were recorded. All perioperative and postoperative complications were monitored. RESULTS: A total of 53 patients underwent the surgical treatment in a 1-day surgery. Seven patients continued antiaggregant therapy with aspirin. Mean preoperative prostatic adenoma volume was 56.6 mL. Mean operative time was 71 minutes. The average catheter time was 14.8 hours. The peak urinary flow rate on day 7 improved from 9.3 to 17.42 mL/s (p<0.001) and the IPSS improved from 18 to 10.2 (p<0.01). Patients were routinely discharged on the day of catheter removal. No complications were recorded. CONCLUSIONS: ThuVEP can be safely conducted as a 1-day surgical procedure. This strategy results in cost savings. ThuVEP shows good standardized outcomes with respect to improvement in flow parameters and length of bladder catheterization.
Aged ; Ambulatory Surgical Procedures ; Humans ; Laser Therapy/adverse effects/*instrumentation ; Lasers, Solid-State/*therapeutic use ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Prospective Studies ; Prostate/*surgery ; Prostatic Hyperplasia/*surgery ; Thulium/*therapeutic use ; Transurethral Resection of Prostate ; Treatment Outcome

PURPOSE: The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here. MATERIALS AND METHODS: From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate. RESULTS: The mean operative time was 82.1+/-33.3 minutes. The mean enucleation time and morcellation time were 52.7+/-21.7 minutes and 8.2+/-7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9+/-24.6 g and 0.4+/-0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively. CONCLUSIONS: The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.
Aged ; Humans ; Lasers, Solid-State/adverse effects/*therapeutic use ; Male ; Middle Aged ; Operative Time ; Prostate-Specific Antigen/blood ; Prostatic Hyperplasia/pathology/*surgery ; Retrospective Studies ; Thulium ; Transurethral Resection of Prostate/adverse effects/*methods ; Treatment Outcome

OBJECTIVETo compare the effect and impact of holmium laser enucleation of the prostate (HoLEP) and 120-W thulium: YAG vapoenucleation of the prostate (ThuVEP) on erectile function in the treatment of benign prostatic hyperplasia (BPH).

METHODSWe retrospectively analyzed 93 cases of symptomatic BPH treated by HoLEP or 120 W ThuVEP. We made comparisons between the two groups of patients in the baseline and postoperative clinical and surgical indexes as well as their IPSS, quality of life (QOL), maximum flow rate (Qmax), postvoid residual urine volume (PVR), and IIEF-EF scores before surgery and during the 12-month follow-up.

RESULTSThuVEP, in comparison with HoLEP, achieved a significantly shorter operation time ([57.6 +/- 12. 8] vs. [70.4 +/- 21.8] min, P = 0.001) and a higher laser efficiency ([0.71 +/- 0.18] vs. [0.62 +/- 0.19] g/min, P = 0. 021). At 1, 6, or 12 months of follow-up, no significant differences were observed in IPSS, OOL, Omax, and PVR between the two groups (P > 0.05). Both the HoLEP and ThuVEP groups showed low incidences of complications and remarkably improved IIEF-EF scores at 12 months postoperatively, but with no significant differences (both P > 0.05). However, in those with relatively normal erectile functions before operation, the mean IIEF-EF score was reduced from 22.8 +/- 2.2 preoperatively to 21.0 +/- 2.7 after HoLEP, (P = 0.036).

CONCLUSIONBoth HoLEP and 120W ThuVEP are effective and safe in the treatment of BPH. Compared with HoLEP, 120 W ThuVEP has even a higher laser efficiency. However, neither can significantly improve erectile function, and HoLEP may have a short-term negative impact on the relatively normal erectile function of the patient.

Aged ; Holmium ; Humans ; Laser Therapy ; adverse effects ; methods ; Lasers, Solid-State ; therapeutic use ; Male ; Middle Aged ; Penile Erection ; Prostatectomy ; adverse effects ; methods ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Retrospective Studies ; Thulium ; Transurethral Resection of Prostate ; Treatment Outcome ; Urine

Objective: To compare thulium laser vaporization of the prostate (TLVP) and transurethral resection of the prostate (TURP) in the treatment of benign prostate hyperplasia (BPH) analyze the risk factors for postoperative urethral stricture. METHODS: From June 2015 to June 2016, 210 BPH patients in our hospital underwent TURP (n = 126) or TLVP (n = 84). We followed up the patients for 6 months, compared the effects of the two surgical strategies and analyzed the risk factors for postoperative urethral stricture by multivariate logistic regression analysis. RESULTS: Compared with TURP, TLVP achieved significantly shorter time of operation (［78.6 ± 27.5］ vs ［53.2 ± 21.6］ min, P <0.01), postoperative bladder irrigation (［31.5 ± 2.9］ vs ［26.1 ± 3.7］ h, P <0.01), urethral catheterization (［5.3 ± 1.7］ vs ［3.7 ± 1.5］ d, P <0.01) and postoperative hospitalization (［7.9 ± 2.1］ vs ［5.5 ± 1.4］ d, P <0.01) as well as lower urinary leukocyte count at 6 months after surgery (［32.1 ± 12.6］ vs ［24.9 ± 11.7］ /μl, P <0.01) and incidence rate of postoperative complications (11.9% ［15/126］ vs 3.6% ［3/84］, P <0.05), particularly that of urethral stricture (7.9% ［10/126］ vs 1.2% ［1/84］, P <0.05). Logistic regression analysis showed that the preoperative urinary leukocyte count, postoperative urethral catheterization time, and surgical method were independent risk factors for postoperative urethral stricture. CONCLUSIONS TLVP, in comparison with TURP, has the advantages of definite effect, fast recovery, high safety and low incidence of postoperative urethral stricture. The main risk factors for postoperative urethral stricture include preoperative urinary tract infection, postoperative urethral catheterization time and surgical method.
Humans ; Laser Therapy ; adverse effects ; methods ; Male ; Operative Time ; Postoperative Complications ; etiology ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Regression Analysis ; Risk Factors ; Thulium ; therapeutic use ; Transurethral Resection of Prostate ; adverse effects ; Treatment Outcome ; Urethral Stricture ; etiology ; Urinary Catheterization ; Urinary Tract Infections ; complications