This study compares the peri-operative and functional outcomes of three distinct surgical techniques in Thulium Laser Enucleation of the Prostate (ThuLEP) for benign prostatic hyperplasia (BPH). The main aim is to assess whether the En-bloc, Three-lobe, and Two-lobe techniques have differential effects on surgical efficacy and patient outcomes.
A retrospective analysis was conducted on patients undergoing ThuLEP for BPH between January 2019 and January 2024 at two tertiary centers. Propensity score matching was utilized to balance baseline characteristics among patients undergoing the different techniques. Surgical parameters, including operative time, enucleation time, morcellation time, energy consumption, and postoperative outcomes, were compared among the groups.
Following propensity score matching, 213 patients were included in the analysis. Intraoperative analysis revealed significantly shorter enucleation, laser enucleation, morcellation and operative times and total energy delivered in the En-bloc and Two-lobe groups compared to the Three-lobe group. No significant differences were observed among the groups in terms of intraoperative and postoperative complications. There were no significant differences in functional outcomes at the 3-month follow-up among the groups.
The findings of this study suggest that while the En-bloc and Two-lobe techniques may offer efficiency benefits and could be considered safe alternatives in ThuLEP procedures, the reduction in laser enucleation time and energy delivered did not necessarily translate into improvements in post operative storage symptoms or other functional outcomes for the patients. Surgeon preference and proficiency may play a crucial role in selecting the most suitable technique for individual patients. Future research should focus on larger-scale prospective studies to further validate these findings and explore potential factors influencing surgical outcomes.
World journal of urology. 2024 Jul 22*** epublish ***
Francesco Cantiello, Fabio Crocerossa, Stefano Alba, Umberto Carbonara, Savio Domenico Pandolfo, Ugo Falagario, Alessandro Veccia, Giuseppe Ucciero, Matteo Ferro, Nicola Mondaini, Rocco Damiano
Department of Urology, Magna Graecia University of Catanzaro, Viale Europa, 100 Catanzaro (CZ), Catanzaro, 88100, Italy., Department of Urology, Magna Graecia University of Catanzaro, Viale Europa, 100 Catanzaro (CZ), Catanzaro, 88100, Italy. ., Department of Urology, Romolo Hospital, Rocca di Neto (Kr), Crotone, Italy., Unit of Urology, GVM - Santa Maria Hospital, Bari, Italy., Department of Urology, University of L'Aquila, L'Aquila, Italy., Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy., Department of Urology, University of Verona, Verona, Italy., Unit of Urology, R. Dulbecco Hospital, Catanzaro, Italy., Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy.