EEP using thulium fiber laser equally effective as high-power holmium laser in large prostates in terms of complications: Study

The researchers also found that thulium fiber laser with the en-bloc technique has a shorter operative time which significantly and positively impacts short- and medium-term functional outcomes.

Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH), primarily due to the use of lasers and bipolar energy and the introduction of morcellators. EEP and holmium laser (HL) enucleation of the prostate, in particular, has demonstrated lower rates of hospital stay and postoperative catheterization, and complications with excellent functional outcomes versus open simple prostatectomy.

With the recent introduction of TFL for EEP which is gaining increasing popularity, there is an urgent to compare with HPHL. Therefore, Ee Jean Lim, Department of Urology, Singapore General Hospital, Singapore, and colleagues aimed to compare perioperative outcomes of EEP between TFL and HPHL for large prostates (≥80 ml in volume), using data from experienced surgeons. Secondary outcomes were to assess complications within one year of follow-up.

For this purpose, they retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centres. Patients with prostate volume ≥80 ml were included, while those with previous prostate/urethral surgery, concomitant prostate cancer, and pelvic radiotherapy were excluded.

The study led to the following findings:

• Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470.
• After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed.
• Overall operative time (90 vs. 52.5 min) and enucleation time (90 vs. 38 min) were longer in the TFL group, with comparable morcellation time (13 vs. 13 min).
• In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis.
• In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation.

The researchers caution that attention to hemostasis in EEP of large prostates with any laser is quintessential to minimize morcellation-related as well as post-operative morbidity.

"Our study successfully shows how EEP is confidently being adopted with different lasers by different techniques even in large prostates," the research team concluded.

Reference:

Lim, E. J., Castellani, D., Somani, B. K., Gökce, M. I., Fong, K. Y., Sancha, F. G., Herrmann, T. R., Biligere, S., Tursunkulov, A. N., Dellabella, M., Sofer, M., Enikeev, D., Petov, V., Gadzhiev, N., Elterman, D., Mahajan, A., Socarras, M. R., Yunusov, D. S., Nasirov, F., . . . Gauhar, V. (2023). High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group. Prostate International. https://doi.org/10.1016/j.prnil.2023.12.001