Thulium Lazer ile Prostat Enükleasyonu(ThuLEP) deneyimleri

Year 2020, Volume: 12 Issue: 2, 99 - 107, 23.07.2020

Eymen Gazel , Mehmet Yılmaz , Halil Çağrı Aybal , Engin Kaya , Serdar Yalçın , Sercan Yılmaz , Onur Açıkgöz Lütfi Tunç

Abstract

Giriş: 1998'den bu yana, Gilling prostatın Holmium Lazer Enükleasyonu'nu (HoLEP) ilk kez tarif ettikten sonra, prostat cerrahisinde lazer kullanımı yaygınlaşmıştır. Prostatın endoskopik cerrahilerinde Thulium lazer enükleasyonu (ThuLEP) da uygulanmaktadır. Thulium lazer cihazı şu anda Türkiye'deki sınırlı sayıda merkezde kullanılmaktadır. Bu çalışmada Türkiye’de ilk ThuLEP vakasının da gerçekleştirildiği merkezimizin sonuçlarını literatüre kazandırmayı amaçladık.

Gereç ve Yöntemler: Temmuz 2018 ile Eylül 2019 arasında ThuLEP ameliyatı olan 60 hastanın verileri retrospektif olarak tarandı . Enükleasyon süresi (ET) (dak), morselasyon süresi (MT) (min), toplam operasyon süresi (OT-toplam) (min), enükleasyon etkinliği (EE) (g / dak) ve morselasyon etkinliği (ME) (g / dak), enükle edilen doku ağırlığı (RTW) (g), enükle edilen doku yüzdesi (PWR) gibi perioperatif veriler ile intraoperatif ve postoperatif komplikasyonlar kaydedildi. Qmax, Qave, Qmax'a Kadar Süre, Voiding Süresi (VT), IPSS, QoL verileri ve postoperatif kontinans durumu postoperatif 1. ay ve 6. ay takibi ile karşılaştırıldı.

Bulgular: Postoperatif fonksiyonel sonuçları gösteren tüm parametrelerde istatistiksel olarak anlamlı iyileşme gözlendi (p <0.001). Hastaların kontinans durumu ile ilgili olarak SUI, UUI ve PMR sırasıyla% 5,% 6.64 ve% 9.96 olarak gözlendi. Bu oranların hastaların 1. ay takibinde gerilediği gözlendi. Hiçbir hastanın 6. ay takiplerinde SUI, UUI ve PMR gözlenmedi.

Sonuçlar: Bu çalışma Türkiye'den bildirilen ilk ThuLEP serisidir. ThuLEP hakkında daha geniş serilere sahip prospektif randomize çalışmaların literatüre katkı sağlayacağına inanıyoruz.

Keywords

ThuLEP, prostat, lazer, thulium, Türkiye

The Experiences of Thulium laser enucleation of the prostate (ThuLEP)

Abstract

Intoduction: Since 1998, after Gilling described Holmium Laser Enucleation of the Prostate (HoLEP) for the first time, laser using in prostate surgery has spread. Thulium laser enucleation of the prostate (ThuLEP) is also applied in endoscopic surgeries of the prostate. Thulium laser device is currently used in a limited number of centres in Turkey. In the present study, we aimed to contribute to the literature with the data of the cases carried out in our centre where the first case of ThuLEP was performed in Turkey.

Material and Methods: The data of 60 patients who underwent Thulep surgery between July 2018 and September 2019 were used in the retrospectively designed study. Perioperative datas such as Enucleation time (ET) (min), morcellation time (MT) (min), total operation time (OT-total) (min), enucleation efficiency (EE) (g/min) and morcellation efficiency (ME) (g/min), enucleated tissue weight (RTW) (g), enucleated tissue percentage (PWR), intraoperative and postoperative complications recorded. Parameters such as Qmax, Qave, Time to Qmax, Voiding Time (VT), IPSS, QoL data and postoperative continence status were compared postoperative 1st month and 6th month follow up.

Results: Statistically significant improvement was observed in all parameters showing functional results after the surgery (p<0.001). Regarding the continence status of patients, SUI, UUI and PMR were observed at 5%, 6.64% and 9.96%, respectively. These rates were observed to regress at the 1st month follow-up of patients. No SUI, UUI, and PMR were observed at the 6th month follow-ups of any patients.

Conclusions: The present study is the first ThuLEP series reported from Turkey. We believe that prospective randomized studies about ThuLEP with larger series would be a contribution to the literature.

Keywords

ThuLEP, prostate, laser, thulium, Turkey

References

• 1. Gratzke C, Bachmann A, Descazeaud A, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol 2015;67:1099-1109.
• 2. Nair SM, Pimentel MA, Gilling PJ. A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia). Curr Urol Rep 2016;17:45.
• 3. Rieken M, Ebinger Mundorff N, Bonkat G, et al. Complications of laser prostatectomy: a review of recent data. World J Urol 2010;28:53-62.
• 4. Xiao KW, Zhou L, He Q, et al. Enucleation of the prostate for benign prostatic hyperplasia thulium laser versus holmium laser: a systematic review and meta-analysis. Lasers Med Sci 2019;34:815-826.
• 5. Vincent MW, Gilling PJ. HoLEP has come of age. World J Urol 2015;33:487-493.
• 6. Fraundorfer MR, Gilling PJ. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 1998;33:69-72.
• 7. Foster HE, Dahm P, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019. J Urol 2019;202:592-598.
• 8. Oelke M, Bachmann A, Descazeaud A, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013;64:118-140.
• 9. Herrmann TR, Bach T, Imkamp F, et al. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol 2010;28:45-51.
• 10. Bach T, Netsch C, Haecker A, et al. Thulium:YAG laser enucleation (VapoEnucleation) of the prostate: safety and durability during intermediate-term follow-up. World J Urol 2010;28:39-43.
• 11. Zhang F, Shao Q, Herrmann TR, et al. Thulium laser versus holmium laser transurethral enucleation of the prostate: 18-month follow-up data of a single center. Urology 2012;79:869-874.
• 12. Raber M, Buchholz NNP, Vercesi A, et al. Thulium laser enucleation of the prostate (ThuLEP): Results, complications, and risk factors in 139 consecutive cases. Arab J Urol 2018;16:411-416.
• 13. Tunc L, Yalcin S, Kaya E, et al. The "Omega Sign": a novel HoLEP technique that improves continence outcomes after enucleation. World J Urol 2020.
• 14. Morgan M, Smith N, Thomas K, et al. Is Clavien the new standard for reporting urological complications? BJU Int 2009;104:434-436.
• 15. Donovan JL, Peters TJ, Abrams P, et al. Scoring the short form ICSmaleSF questionnaire. International Continence Society. J Urol 2000;164:1948-1955.
• 16. Becker B, Herrmann TRW, Gross AJ, et al. Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J Urol 2018;36:1663-1671.
• 17. Gilling PJ. Laser enucleation is increasingly becoming the standard of care for treatment of benign prostatic hyperplasia of all sizes. Eur Urol 2013;63:868-869; discussion 870-861.
• 18. Yuan R, Boyu Y, Fujun Z, et al. Transurethral thulium laser enucleation versus resection of the prostate for treating benign prostatic hyperplasia: a retrospective study. Lasers Med Sci 2019;34:329-334.
• 19. Elshal AM, Elmansy HM, Elhilali MM. Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes. Urology 2013;81:634-639.
• 20. Majumdar R, Mirheydar HS, Palazzi KL, et al. Prostate laser vaporization is safe and effective in elderly men. Urol Ann 2015;7:36-40.
• 21. Castellani D, Pirola GM, Gasparri L, et al. Are Outcomes of Thulium Laser Enucleation of the Prostate Different in Men Aged 75 and Over? A Propensity Score Analysis. Urology 2019;132:170-176.
• 22. Gratzke C, Schlenker B, Seitz M, et al. Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol 2007;177:1419-1422.
• 23. Bach T, Netsch C, Pohlmann L, et al. Thulium:YAG vapoenucleation in large volume prostates. J Urol 2011;186:2323-2327.
• 24. Becker B, Orywal AK, Gross AJ, et al. Thulium vapoenucleation of the prostate (ThuVEP) for prostates larger than 85 ml: long-term durability of the procedure. Lasers Med Sci 2019;34:1637-1643.
• 25. Pearce SM, Pariser JJ, Malik RD, et al. Outcomes following Thulium vapoenucleation of large prostates. Int Braz J Urol 2016;42:757-765.
• 26. Zhang J, Ou Z, Zhang X, et al. Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results. World J Urol 2019.
• 27. Oh SJ. Current surgical techniques of enucleation in holmium laser enucleation of the prostate. Investig Clin Urol 2019;60:333-342.
• 28. Large T, Krambeck AE. Evidence-based outcomes of holmium laser enucleation of the prostate. Curr Opin Urol 2018;28:301-308.
• 29. Iacono F, Prezioso D, Di Lauro G, et al. Efficacy and safety profile of a novel technique, ThuLEP (Thulium laser enucleation of the prostate) for the treatment of benign prostate hypertrophy. Our experience on 148 patients. BMC Surg 2012;12 Suppl 1:S21.
• 30. Sun F, Han B, Cui D, et al. Long-term results of thulium laser resection of the prostate: a prospective study at multiple centers. World J Urol 2015;33:503-508.