Functional outcomes of transurethral thulium laser enucleation versus bipolar transurethral resection for benign prostatic hyperplasia over a period of 12 months: A prospective randomized study

Abstract

To evaluate functional outcomes over a year for benign prostatic hyperplasia treated with thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate. Methods: In this study, we prospectively included 140 patients who were treated for benign prostatic hyperplasia from April 2017 to February 2019. A randomization list was used for non-blind assignment to treatment groups (thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate). The International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, uroflowmetry and International Index of Erectile Function-5 were used for the assessment of outcomes. Scores were taken before treatment, and at 1, 3, 6, 9 and 12 months after treatment. Results: Preoperatively, characteristics of patients in the thulium laser enucleation of the prostate group (n = 70) and the bipolar transurethral resection of the prostate group (n = 70) did not significantly differ. The thulium laser enucleation of the prostate group had a lower median decrease in hemoglobin (0.10 g/dL vs 0.69 g/dL, P < 0.0001) and shorter median catheterization (2 days vs 3 days, P < 0.0001) than the bipolar transurethral resection of the prostate group. Both groups had significantly improved International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, maximum flow rate and residual urine compared with preoperative values. In the thulium laser enucleation of the prostate group, erectile function was significantly impaired at 1 month post-treatment compared with pretreatment, but improved to baseline at 3 months; however, the transurethral resection of the prostate group did not recover. However, total energy (P = 0.001) and laser irradiation time (P = 0.025) were significantly different between the patients who had preserved erectile function and those who did not after the treatment in the thulium laser enucleation of the prostate group. Conclusions: Thulium laser enucleation of the prostate is superior to bipolar transurethral resection of the prostate in resection efficacy, hemostasis, catheterization time and preservation of erectile function. However, excessive laser irradiation time in thulium laser enucleation of the prostate has the possibility to delay improvement of overactive bladder symptoms and decrease sexual function.

Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis

“…We found the risk of bias for randomized clinical trials to be high for 3 studies 32 , 34 , 35 due to absence of allocation concealment (not reported by 2 studies 32 , 34 and lacking mention of blinding in the other). 1 study 31 had a moderate risk as the information provided was unclear.…”

“…Comparative Studies Assessing Tm:YAG Prostate Surgery Versus TURP Four RCTs 31,32,34,35 and one retrospective study 33 in our meta-analysis compared sexual outcomes after either Tm:YAG assisted prostate surgery or TURP. 2 of these studies 31,34 used a TmLRP technique and the other three 32,33,35 used a TmLEP technique. 2 studies 31,34 were carried out in China and the others in Japan, Russia, and Poland.…”

“…This systematic review and meta-analysis included a total of thirteen studies, 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 out of which five 31 , 32 , 33 , 34 , 35 were comparative clinical studies on the sexual outcomes between the Tm:YAG prostate surgery and TURP, and eight 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 were single arm interventional prospective cohort studies assessing sexual outcomes after Tm:YAG for BPH.…”

“…Four RCTs 31 , 32 , 34 , 35 and one retrospective study 33 in our meta-analysis compared sexual outcomes after either Tm:YAG assisted prostate surgery or TURP. 2 of these studies 31 , 34 used a TmLRP technique and the other three 32 , 33 , 35 used a TmLEP technique.…”

The effectiveness and safety of three surgical procedures for the treatment for benign prostatic hyperplasia: A network meta-analysis

“…A preliminary review of 6421 papers from various databases was conducted, and after a screening process, finally, 27 papers included in the analysis [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] and involved studies that were all two-by-two comparisons. Besides, the total number of literature on the comparison of HoLEP and TURP was 19 [ 11 , 12 , 13 , 14 , 16 , 17 , 18 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 ] and 5 [ 15 , 19 , 21 , 35 , 36 ] on ThuLEP and TURP respectively, and 3 on the comparison of HoLEP and ThuLEP [ 8 , 20 , 37 ]. The results of the literature screening process are shown in Figure 1 .…”