Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it’s time to pull the rabbit out of the hat

Maruccia, Serena; Fulgheri, Irene; Montanari, Emanuele; Casellato, Stefano; Boeri, Luca

doi:10.1007/s10103-020-03227-4

Cited by 3 publications

(6 citation statements)

References 87 publications

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“…They might differ due to differences in equipment, laser settings, or even alterations of the surgical steps. This issue was pointed out in a recently published narrative review from Maruccia S et al comparing techniques for endoscopic thulium laser surgery of the prostate (60). Most notably, 42% of all included studies were classified as discordant in terms of procedural description.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic enucleation of the prostate (EEP). The same but different—a systematic review

et al. 2021

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Purpose Various techniques for EEP exist. They differ by surgical steps and the source of energy. It is assumed that the latter is of minor importance, whereas adherence to the anatomical enucleation template determines the postoperative result. So far, no systematic review highlights the differences between the energy sources in use for anatomical EEP. This study will address selfsame topic. Methods A systematic review of the literature was completed on September 1st, 2020. Studies comparing HoLEP, ThuLEP, DiLEP, or BipolEP with TUR-P providing 12 months of postoperative follow-up were included. Two frequentist network meta-analyses were created to compare the techniques of EEP indirectly. Results 31 studies, including 4466 patients, were found eligible for our meta-analysis. Indirect pairwise comparison showed differences in surgery time between BipolEP and HolEP (MD − 16.72 min., 95% CI − 27.75 to − 5.69) and DiLEP and HoLEP (MD − 22.41 min., 95% CI − 39.43 to − 5.39). No differences in the amount of resected prostatic tissue, major and minor complications and postoperative catheterization time were found. The odds for blood transfusions were threefold higher for BipolEP than for HoLEP (OR 3.27, 95% CI 1.02–10.5). The difference was not statistically significant when comparing prospective trials and matched-pair analysis only (OR 3.25, 95% CI 0.94–11.18). The Qmax 12 months after surgery was 2 ml/sec. higher for BipolEP than for DiLEP (MD 2.00, 95% CI 0.17–3.84) and 1.94 ml/sec. lower for DiLEP than for HoLEP (MD − 1.94, 95% CI − 3.65 to − 0.22). Conclusion The energy source used for EEP has an impact on the intervention itself. BipolEP promotes surgical efficiency; laser techniques lower the risk of bleeding. Registry This meta-analysis is registered in the PROSPERO international prospective register registry with the registration number CRD42020205836.

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Section: Discussionmentioning

confidence: 99%

Endoscopic enucleation of the prostate (EEP). The same but different—a systematic review

et al. 2021

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“…Both side and frontal fibers can be used to perform this technique." The study highlights the difference between techniques to fill the gap in literature in terms of comparison between technique, the standardization has the goal to uniform the terminology to allow the comparability between surgical approaches in terms of outcomes and surgical skills [2]. There is a lack in literature about high power thulium vaporization at 200W, the power rate commonly reported for vaporization is between 70W and 150W.…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines of the European Association of Urology recommend surgical endoscopic treatment as a gold standard therapy for BPH especially TURP (Trans Urethral Resection of Prostate) [1]. Innovations in the field of laser technologies has allowed these to be employed for prostate adenoma vaporization and enucleation [2]. Those techniques are considered a valid alternative to TURP with accurate preoperative patient selection.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of High energy ThuVAP (Thulium laser Vaporization of Prostatic Adenoma) at 200W

2022

J Surg

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Objectives: BPH is a common condition afflicting the aging male. The aim of our study is to highlight the safety and efficacy of high power (200 Watt) ThuVAP as a valid alternative treatment option for BPH unresponsive to medical therapy and associated with LUTS.Methods: Patients with BPH unresponsive to conventional therapy were treated with ThuVAP at high power -200Watts (between July 2020 -December 2021). 106 patients were enrolled and 98 underwent surgery. ThuVAP was performed with a standard Iglesias 26ch resectoscope employing a 800µm fiber with a continuous mode 200Watt setting for vaporization and a 30Watt setting for hemostasis on a Quanta system Cyber TM thulium laser. Patients were evaluated pre-and post operatively by an senior consultant urologists.Results: A total of 98 patients were treated. Patient preoperative characteristics were: mean IPSS of 26, mean QOL of 5, preop Qmax 5.7±4.3ml/sec, PVR 173±35 ml, prostate size (as measure on transrectal ultrasound) 133±65 ml, prostate adenoma size 94±40 ml, mean PSA 4.14 ng/ml. Post operative characteristics were evaluated at 45 days after surgery and evidenced mean IPSS of 12, QOL 1.3, Qmax 19.7±3.2ml/sec, PVR 21±5ml, PSA 1.1ng/ml. All patients referred improvement regarding symptoms and QOL with ameliorated perception of voiding as confirmed by uroflowmetry values. No adverse events were recorded. Conclusions:Our study showed that 200watt ThuVAP is a safe, repeatable, and effective treatment modality in patients with symptomatic BPH unresponsive to conventional therapy.

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“…Снижение Hb зарегистрировали в 68 исследованиях, методы испарения и энуклеации оценены с Б-ТУРП и показали себя лучше, чем М-ТУРП. По сравнению с М-ТУРП Hb снизился на 12,5 г/л (8,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)6) для КТФЛВП и на 1,9 г/л (0,1-3,8) для Б-ТУРП (см. рис.…”

Section: интраоперационные параметрыunclassified

“…Среда усиления, генерирующая лазерный луч тулиевой установки, представляет собой простое и очень длинное активное волокно, содержащее ион тулия, с очень тонкой сердцевиной (диаметр сердечника 10-20 мкм). Поскольку лазерный луч исходит из этого небольшого волоконного сердечника, сам луч может быть напрямую доставлен к тканям путем присоединения любого отдельного волокна для доставки его к цели [6][7][8]. В табл.…”

Section: Introductionunclassified

Actual aspects of the use of thulium laser as a promising method in the treatment of prostatic hyperplasia

Shiryaev¹,

Govorov²,

Vasilyev³

et al. 2021

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Lower urinary tract symptoms caused by benign prostatic hyperplasia are the most widespread and frequent urological problem among men, affecting about a third of the male population of Russia over 50 years of age. Surgical intervention is the most effective method of treating benign prostatic hyperplasia, and about 75,000 surgical interventions are performed annually in Russia. Today, of all available surgical treatments, monopolar transurethral resection of the prostate (TURP), in which enlarged prostate tissue is resected with a monopolar electrode, has been the preferred surgical method since the 1970s. This method of therapy can significantly improve the maximum urinary flow rate (Qmax), reduce obstructive symptoms assessed on the basis of the international questionnaire on the severity (IPSS) and improve the quality of life of patients. However, monopolar TURP is a rather risky procedure due to the possibility of developing serious complications such as massive bleeding or TURP syndrome (water intoxication syndrome of the body). Consequently, practicing urologists all over the world are faced with the urgent task of developing minimally invasive surgical methods of treatment, the results of which would be at least similar to those after monopolar TURP, while with fewer intra- and postoperative complications, side effects and a shorter recovery period for the patient.

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Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it’s time to pull the rabbit out of the hat

Cited by 3 publications

References 87 publications

Endoscopic enucleation of the prostate (EEP). The same but different—a systematic review

Endoscopic enucleation of the prostate (EEP). The same but different—a systematic review

Efficacy and Safety of High energy ThuVAP (Thulium laser Vaporization of Prostatic Adenoma) at 200W

Actual aspects of the use of thulium laser as a promising method in the treatment of prostatic hyperplasia

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