Elsevier

European Urology

Volume 53, Issue 2, February 2008, Pages 382-390
European Urology

Benign Prostatic Obstruction
Thulium Laser versus Standard Transurethral Resection of the Prostate: A Randomized Prospective Trial

https://doi.org/10.1016/j.eururo.2007.05.019Get rights and content

Abstract

Objective

Thulium laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. To our knowledge we report the first prospective, randomized study comparing TmLRP-TT and standard TURP for symptomatic BPH.

Methods

From November 2004 to December 2005, 100 consecutive BPH patients were randomized for surgical treatment with TmLRP-TT (n = 52) or TURP (n = 48). All patients were preoperatively assessed with subjective symptoms score, International Index of Erectile Function questionnaire, and complete urodynamic evaluation. Preoperative and perioperative parameters at 1-, 6-, and 12-mo follow-up were also evaluated. All complications were recorded.

Results

TmLRP-TT was significantly superior to TURP in terms of catheterization time (45.7 ± 25.8 h vs. 87.4 ± 33.8 h, p < 0.0001), hospital stay (115.1 ± 25.5 h vs. 161.1 ± 33.8 h, p < 0.0001), and drop in hemoglobin (0.92 ± 0.82 g/dl vs. 1.46 ± 0.65 g/dl, p < 0.001), whereas it required equivalent time to perform (46.3 ± 16.2 vs. 50.4 ± 20.7 min, p > 0.05). TmLRP-TT and TURP resulted in a significant improvement from baseline in terms of subjective symptoms scoring and urodynamic finding, but no significant difference was found between the two groups. Late complications were also comparable.

Conclusions

TmLRP-TT is an almost bloodless procedure with high efficacy and little perioperative morbidity. TmLRP-TT is superior to TURP in safety and is as efficacious as TURP in 1-yr follow-up. It is a promising technology in the clinical practice field.

Introduction

Transurethral resection of prostate (TURP) is generally considered the gold standard for surgical treatment of benign prostatic hyperplasia (BPH) [1]. Complications and morbidity related to this procedure, such as blood loss, fluid balance disturbances, excessive fluid absorption, incontinence, and erectile dysfunction led to the development and investigation of new techniques. Technological alternatives such as laser treatments may further minimize the risks of this technically difficult procedure [2], and will probably challenge TURP and open prostatectomy [3]. Holmium laser enucleation of the prostate (HoLEP) appears to be a size-independent new gold standard [4]. It allows patients with large prostates who traditionally require open prostatectomy to be treated endoscopically [5]. Potassium-titanyl-phosphate laser vaporization achieves genuine instant tissue ablation, promising durable results. However, its potential has to be confirmed by randomized, controlled, long-term studies in the future [6].

Thulium laser is a new surgical laser, with tunable wavelength between 1.75 μm and 2.22 μm. It may have several advantages over the holmium laser, including improved spatial beam quality, more precise tissue incision, and operation in continuous-wave/pulsed modes [7]. Thulium laser has been proved capable of rapid vaporization and coagulation of prostate tissue [8], whereas cutting and ablation characters are excellent at 50-W energy level. Therefore a thulium laser procedure called “thulium laser resection of prostate-tangerine technique” (TmLRP-TT) was designed and performed for the treatment of BPH [9]. To our knowledge we describe the first prospective, randomized trial comparing TmLRP-TT and TURP for urodynamically obstructive BPH at 1-yr follow-up.

Section snippets

Patients

From November 2004 to December 2005, 100 consecutive BPH patients were randomized to surgical treatment with TmLRP-TT (52 in group 1) or TURP (48 in group 2).

Inclusion criteria were age younger than 85 yr, maximum urinary flow rate (Qmax) less than 15 ml/s, postvoid residual (PVR) urine volume less than 150 ml, medical therapy failure, transrectal ultrasound (TRUS) adenoma volume less than 100 g, and urodynamic obstruction (Schäfer grade 2 or greater).

Exclusion criteria were neurogenic bladder; a

Results

Table 1 lists the baseline characteristics of all men. There was no statistically significant difference in any parameters between the two groups. Table 2 lists perioperative data. A mean total of 50 kJ of energy was used in the TmLRP-TT group, which required the same time as TURP. Although the resected weight of tissue in the TmLRP-TT group was significantly less than that in the TURP group, there was no significant difference in estimated resection tissue weight between the two groups because

Discussion

Thulium laser is a new type of surgical laser, which recently has been applied in urology. Its first advantage is that the center wavelength of the laser is tunable between 1.75 μm and 2.22 μm, allowing the wavelength to exactly match the 1.92-μm water absorption peak in tissue. Higher absorption of the laser radiation at the thulium wavelength results in more efficient and rapid tissue cutting. At the same time, it theoretically causes a smaller thermal damage zone in the tissue. A thin layer of

Conclusion

The tangerine technique is almost a bloodless procedure with high efficacy for treating symptomatic BPH, with little perioperative morbidity. TmLRP-TT is superior to TURP in safety, is as efficacious as TURP, and is a promising technology in the clinical practice field. The 1-yr follow-up results are encouraging, and longer-term follow-up is needed to evaluate the procedure's durability.

Conflicts of interest

The authors have nothing to disclose.

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