Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients

Abstract

Objective We aimed to determine safety and feasibility of thulium laser transurethral vapoenucleation of prostate (ThuVEP) for treatment of obese patients affected by benign prostatic hyperplasia (BPH). Methods We retrospectively analysed data of 452 patients with BPH who underwent ThuVEP from February 2012 to March 2016 in a single center. Patients were divided into three groups according to body mass index (BMI, kg/m 2 ): Normal weight (18.5 ≤ BMI < 25; Group A), overweight (25 ≤ BMI < 30; Group B) and obese (BMI ≥ 30; Group C), for a total of 412 patients evaluable for this study. Preoperative total serum prostate-specific antigen (PSA), digital rectal examination of the prostate, transrectal ultrasound (TRUS), renal ultrasound, urine culture, uroflowmetry, International Prostate Symptoms Score (IPSS), and Quality of Life (QoL) score were analyzed. Post-operative complications, hospital stay and days of catheterization, questionnaires and uroflowmetry at 1 and 3 months after surgery were evaluated. Preoperative data, surgical outcomes, complication rate and clinical outcomes were compared between groups. Results The median age of patients was 69 years (Interquartile Range [IQR 10]). The preoperative median IPSS among groups was 19 (IQR 8.75), 20 (IQR 10), and 18 (IQR 10) respectively. At 1 and 3 months of follow-up, this value was 8 (IQR 7), 8 (IQR 4), 7 (IQR 5) and 5 (IQR 6.25), 5 (IQR 6), 6 (IQR 5), respectively (all p between groups > 0.05). There was no statistically significant difference among three groups as for hospital stay and days of catheterization ( p > 0.05). Conclusion Our results showed that ThuVEP was safe and feasible even in overweight patients with substantially enlarged prostate.

How obesity affects the benefits of holmium laser enucleation of the prostate for the treatment of male lower urinary tract symptoms

“…Based on our data, and corroborating the results of Carmignani et al on safety and feasibility of thulium laser enucleation of the prostate (ThuLEP), we could show that HoLEP is an effective and safe treatment option in LUTS/ BPO in overweight and obese patients and is even superior to TURP. 7,29 To the best of our knowledge, this is the first study analysing the clinical value and impact of obesity on feasibility and postoperative functional outcomes of HoLEP in overweight and obese patients in such a large patient cohort (n=877). Obesity defined solely by BMI most certainly poses a limitation of this study.…”

“…Based on our data, and corroborating the results of Carmignani et al on safety and feasibility of thulium laser enucleation of the prostate (ThuLEP), we could show that HoLEP is an effective and safe treatment option in LUTS/BPO in overweight and obese patients and is even superior to TURP. 7,29…”

“…3,4 HoLEP is fast, efficient and independent of prostate size, and its effectiveness in relief of LUTS is comparable with OP. [5][6][7] Benefits associated with HoLEP, such as less blood loss, shorter catheterization time and hospital stay, seem durable in long-term follow-up. Thus, it has even been considered the "new gold standard" for surgical intervention in LUTS secondary to BPO.…”