Thulium:YAG Vapoenucleation in Large Volume Prostates

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Abstract
Tm:YAG vapoenucleation was introduced as a minimally invasive treatment in patients with benign prostatic obstruction. The efficiency and safety of Tm:YAG vapoenucleation must still be confirmed in large volume prostates to prove the size independence of this promising treatment option. We evaluated the safety and efficiency of Tm:YAG vapoenucleation in patients with a prostate volume of 80 cc or greater and benign prostatic obstruction during a 12-month followup. Included in this trial were 90 consecutive patients undergoing 90 W Tm:YAG vapoenucleation. Vapoenucleation was done using the 2 μm continuous wave Tm:YAG laser combined with a mechanical tissue morcellator. We analyzed patient demographic, perioperative and 12-month followup data. Complications were assessed. Mean preoperative prostate volume was 108.6 cc (range 80 to 200), mean International Prostate Symptom Score was 23.5 (range 8 to 35) and mean quality of life score was 4.3 (range 1 to 6). There was an 86% reduction (range 67% to 99%) in prostate volume on transrectal ultrasound by 12 months and an 88% decrease (range 58% to 100%) in prostate specific antigen. International Index of Erectile Function score remained stable. Peak urinary flow rate, International Prostate Symptom Score and quality of life improved significantly (p <0.001), as did post-void residual urine. The overall complication rate was manageable. Two patients required blood transfusion and 10 experienced early postoperative stress incontinence. During followup 7% of patients had symptomatic urinary tract infection and 2 had persistent grade I stress urinary incontinence. The reoperation rate due to urethral stricture was 1.8% during the 12-month followup. Tm:YAG vapoenucleation is a safe, effective and size independent treatment option for benign prostatic obstruction. As shown by reductions in transrectal ultrasound prostate volume and prostate specific antigen, complete removal of the adenoma can be achieved by this procedure.

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