Thulium YAG is the Best Laser for the Prostate Because of Versatility

Herrmann, Thomas; Becker, Benedikt; Netsch, Christopher

doi:10.1016/j.euros.2022.09.020

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…In soft tissue surgery, TFL claims momentum in transurethral prostate surgery, as studies could demonstrate no significant clinical and surgical difference towards holmium:YAG. However, the mainstay of TFL is its application in stone therapy, with the advantage of less retropulsion and better dusting abilities [28][29][30]. Regarding the impact on tissue, Huusmann et al reported less carbonization by the pulse Tm:YAG than by continuous wave mode and less trauma than by the holmium:YAG laser [31].…”

Section: Discussionmentioning

confidence: 99%

Early Results after Thulium Laser Enucleation of the Prostate in Patients with Urodynamically Proven Detrusor Underactivity

Trotsenko,

Wetterauer,

Haydter

et al. 2024

SIUJ

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Objectives: Benign prostatic hyperplasia is one of the most common urological diseases. Among these patients, the presence of detrusor underactivity or acontractility represents a challenging condition since no medical treatment is available. Our objective is to evaluate early term outcomes following transurethral anatomical enucleation of the prostate with Tm:YAG support. Methods: In a retrospective analysis of 115 patients who underwent this procedure between January 2019 and March 2022 due to lower urinary tract symptoms, 8 patients with urodynamic evidence of detrusor underactivity secondary to a non-neurogenic aetiology were identified. Detrusor underactivity was defined as a bladder contractility index of <100. Results: Median age, prostate volume and bladder contractility index were 73.2 years, 78.5 cm3 and 63.9, respectively. Median International Prostate Symptom Score/quality of life, Qmax and post-void residual volume were 15/3.5 points, 4.4 mL/s and 189 mL, respectively. Postoperatively, immediate catheter-removal success rate was 87.5% (7/8), at 2 months all patients were catheter-free and remained so at 1-year follow-up. Significant improvements for quality of life, Qmax and post-void residual volume were detected. Median postoperative International Prostate Symptom Score/Quality of life, Qmax and post-void residual volume were 7/2, 21.6 mL/s and 0 mL, respectively. Conclusions: This surgical approach offers high catheter-free rates, significantly improves functional voiding parameters and increases patient satisfaction in patients with benign prostatic hyperplasia and concomitant detrusor underactivity. Therefore, it can be regarded as an effective approach for such patients.

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Section: Discussionmentioning

confidence: 99%

Early Results after Thulium Laser Enucleation of the Prostate in Patients with Urodynamically Proven Detrusor Underactivity

Trotsenko,

Wetterauer,

Haydter

et al. 2024

SIUJ

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“…Socarrás et al (2022) [10] и T.R.W. Herrmann et al (2022) [11] соответственно. Можно было бы возразить, что исключение лазера GreenLight из дискуссии несколько несправедливо, но мы считаем, что его надёжная, но ограниченная роль в вапоризации простаты в эпоху эндоскопической энуклеации простаты (ЭЭП), достаточна в качестве критерия исключения [12,13].…”

Section: Original Articlesunclassified

Laser technologies in surgery for benign prostate hyperplasia

Rakhimov,

Feofilov,

Arbuzov

2024

Vestn. Urol.

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Introduction. Benign prostatic hyperplasia (BPH) is a multifactorial and widespread problem of modern medicine, which has not only medical but also social significance. The presence of lower urinary tract symptoms (LUTS) in men has a negative impact on the quality of life. One of the modern surgical methods for treating BPH is the use of laser technologies.Objective. To compare the effectiveness and safety of laser technologies using the example of the use of diode and thulium lasers in BPH surgery.Materials & methods. The study included 89 men with BPH who underwent surgery from 2020 to 2022. Patients were divided into two groups: in group 1 (n = 37) photoselective vaporization of the prostate was performed using a Diode Laser Vaporization of the Prostate (DiVAP), in group 2 (n = 52) - Thulium Laser Enucleation of the Prostate (ThuLEP). To assess the results of treatment, we studied indicators of maximum urine flow, residual urine volume, prostate volume, prostate-specific antigen level, severity of LUTS (IPSS scale) and symptoms of erectile dysfunction (IIEF-5 scale), level of quality of life (QoL index) and the frequency of postoperative complications. The outcomes were assessed at baseline and 3, 6, 12 months after the procedure. The duration of the operation, the duration of catheterization and the length of stay of patients in the hospital were also recorded.Results. At a long-term follow-up (12 months), the effectiveness of DiVAP and ThuLEP was comparable in terms of prostate volume (24.0 and 24.3 cm3), PSA level (3.3 and 3.4 ng/ml) and quality of life of patients related to urination (2.3 and 2.0 points). The severity of LUTS one year after treatment was also comparable in the groups (4.1 and 4.6 points), however, the IPSS scale scores was more favorable in the ThuLEP group at three- and six-month follow-up points (3 months: 14.9 and 10.0 points; 6 months: 9.3 and 7.5 points). At the same time, ThuLEP also turned out to be more effective in the rate of maximum urine flow achieved after a year (15.2 and 25.8 ml/s), the residual urine volume (8.2 and 2.2 ml), and IIEF-5 questionnaire score (22, 4 and 24.4 points), DiVAP - by operation time (58.5 and 84.6 minutes) and catheterization duration (26.8 and 32.5 hours). There were no statistically significant differences in the duration of hospitalization (2.2 and 2.1 days). Postoperative complications are recorded 2 times more often with DiVAP than after ThuLEP.Conclusions. The study confirmed the high efficiency of endoscopic laser enucleation (ThuLEP) and laser vaporization (DiVAP) technologies. The safety of ThuLEP is due to the lower incidence of postoperative complications compared to DiVAP. The success of laser operations directly depends on careful selection of patients, as well as the experience of the surgeon.

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“…The present debate on the best option for BPH involves three lasers: the TFL “new kid on the block” [2] supported by Enikeev and Taratkin [3] ; and two traditional lasers, Ho:YAG endorsed by Rodriguez Socarrás et al [4] and Tm:YAG promoted by Herrmann et al [5] , both recently updated by substantial technological innovations [6] , [7] , [8] . It could be argued that exclusion of the GreenLight laser from the debate is somewhat unfair, but we believe that its robust but limited role in prostate vaporization in the era of endoscopic enucleation of the prostate (EEP) [1] , [9] is sufficient as an exclusion criterion.…”

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confidence: 99%