To provide the first large single-operator case series of patients who undergo "en bloc" thulium laser enucleation of the prostate (ThuLEP) and to demonstrate an improvement in enucleation efficacy with experience.
We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent "en bloc" ThuLEP between May 2015 and November 2017. Association between dependent variables (delivered energy and operating time) and independent variables (adenoma volume and experience) were estimated with regression analysis. The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.
A total of 100 patients were registered for the study. Median operative time was 56.5 min (interquartile range [IQR]: 40-85 min). Median enucleation time was 17.4 min (IQR: 15-21.5 min). Median enucleation index (enucleation time per adenoma gram) was 0.3 min/g (0.2-0.3 min/g). The overall operative time is not influenced by experience, but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram (p = 0.0148).
We believe that further attention is needed for these new "en bloc" prostatic enucleation techniques, which can facilitate some surgical steps, leading to a widespread use of laser technology for BPH surgical treatment.
Asian journal of urology. 2019 Feb 04 [Epub]
Giovanni Saredi, Giacomo Maria Pirola, Francesca Ambrosini, Simone Barbieri, Lorenzo Berti, Andrea Pacchetti, Domenico Iovino, Giuseppe Ietto, Letizia Libassi, Giulio Carcano
Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy., Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy., Centro Cardiologico Monzino, IRCCS, Milan, Italy., Department of Urology, University of Genova, Genova, Italy., Department of Surgery, University of Insubria, Varese, Italy.