Long-term outcome following Thulium VapoEnucleation of the prostate

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Abstract
To evaluate Thulium VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) with long-term follow-up. A prospective analysis of 124 patients who underwent ThuVEP between January 2007 and July 2008 at our institution was done. ThuVEP was carried out using the 70-Watt 2-μm continuous wave Tm:YAG laser. Patient demographic, perioperative complications, and follow-up data were analysed. The median (interquartile range) preoperative prostate volume was 58.5 (45–70.75) cc. The median operation and enucleation time were 74 (60–100) and 32.54 (25.62–37.52) min, respectively. The median catheter time and postoperative hospital stay were 2 (2–2) and 4 (3–5) days, respectively. Nine (7.3 %) patients required a second-look operation in the immediate postoperative course (failed morcellation = 2, clot retention = 3, and residual adenoma = 4). Two patients needed blood transfusions (1.6 %) postoperatively. At 12-month follow-up, International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoiding residual urine (PVR) improved significantly in comparison with preoperative assessment (p < 0.001). A significant decrease of median PSA (4.7 vs. 0.92 μg/l) was seen at one-year follow-up (p < 0.001). At the 48-month follow-up mark, Qmax, PVR, IPSS, and QoL still differed significantly from baseline (p < 0.001). Bladder neck contractures and urethral strictures each developed in 1.6 and 0.8 % of the patients during follow-up. None of the patients were re-treated during follow-up for recurrent prostatic tissue. ThuVEP is a safe, efficacious, and durable procedure for the treatment of BPO. The incidence of late complications with ThuVEP was low.

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