Low-power thulium laser enucleation of the prostate found efficacious in prostates larger than 80 mL

Recently presented research indicate that low-power thulium laser enucleation of the prostate is efficient and yields satisfactory urinary and sexual outcomes in prostates larger than 80 mL.¹

The findings were presented at the 2022 American Urological Association Annual Meeting in New Orleans, Louisiana.

The study evaluated 37 patients with symptomatic BPH who had failed medical treatment or developed BPH-related complications. Patients with prostate size larger than 80 mL and who were candidates for thulium laser enucleation of the prostate between December 2019 to June 2021 were included in the study. The investigators utilized a 30 W thulium laser with a 550µm laser fiber and a 26 Fr continuous flow resectoscope. They collected information on prostate size, prostate-specific antigen (PSA), enucleation and morcellation time, postoperative International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) score at 1 week and 1, 3, and 6 months.

Mean patient age was 68 ± 6 years. Main indications for surgery were failed medical treatment (70.3%), refractory retention (21.6%), and hematuria (8%). The investigators reported mean prostate size of 111 ± 20 mL and a mean Qmax of 6.8 ± 2 mL/sec.

“The mean enucleation time was 70 ± 10 min, and the mean morcellation time was 24 ± 6 min,” wrote the authors, led by Samer Morsy, MD, of Cairo University, Egypt.

The investigators observed a mean reduction in PSA of 3.4 ± 1.1 ng/mL and a mean hemoglobin drop of 1.7 ± 0.6 mg/dL. During the first follow-up visit at 1 week, mean IPSS was 8.3 ± 1.9 and a mean Qmax improvement of 26 ± 4.6 mL/s was observed.

“Our results showed significant improvement in postoperative urgency and UUI (P = .005) with no significant change in IIEF-5 score at 6-month follow-up compared to baseline,” wrote the authors.

Commenting on the study findings in a video posted on www.urologytimes.com, Amy E. Krambeck, MD, said, “They did an excellent study with great follow-up and showed that low power thulium laser enucleation of the prostate is in fact safe and feasible in their hands.” Krambeck, professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois, was not involved with the research.

Reference

1. Morsy S, Kamal I, Meshref A, et al. Efficacy of low-power thulium laser enucleation of prostate larger than 80 grams. J Urol. 2022;207(5S):e1035-1036. doi:10.1097/JU.0000000000002669.02