Presented by: Vineet Gauhar MCh uro, Dip MIS Uro
Ng teng fong general hospital

Introduction

The Refinement in Endoscopic Anatomical Prostate enucleation database (REAP) retrospective registry was created to understand and identify the nuances and preferences in global practice of prostate enucleation by inviting experienced surgeons from centres around the world. This study aims to compare and contrast the Holmium laser with MOSES (MoLEP) and Thulium fibre laser enucleation of the prostate (ThuFLEP) in term of surgical and functional outcomes,

Materials

A retrospective analysis of all patients who underwent either procedures in 5 centres (January 2020-January 2022). Exclusion criteria: previous urethral/prostatic surgery, radiotherapy concomitant surgery. Propensity score matching (PSM) analysis was performed to adjust for the bias inherent to the different characteristics at baseline. Differences between procedures were estimated for international prostate symptom score (IPSS), quality of life (QL), maximum flow rate (Qmax).

Results

,

PSM retrieved 118 patients in each. Baseline characteristics were similar except for PSA and number of men on indwelling catheter (higher in MoLEP group). Median surgical time was significantly longer in the MoLEP.Median catheter dwelling time and postoperative stay were similar. Early complications were mainly Clavien ≤2.Rate and type of early and persistent incontinence (>3 months) was similar. At 12-month patients reaching a decrease (Δ) of IPSS≥18 from baseline was significantly larger with MoLEP.

Conclusion

This is the first real-world study reporting outcomes up to 1 year comparing MoLEP vs ThuFLEP. Both were safe and efficacious with similar short-term operative and functional outcomes. At 1-year, MoLEP patients had a sustained reduction of IPPS score. This information can help in counselling patients.

Funding

nil 

Lead Authors

Daniele Castellani, MD
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche

Co-Authors

Fernando Gómez Sancha, MD
Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO

Dmitry Enikeev, md
Institute for Urology and Reproductive Health, Sechenov University

Nariman Gadzhiev, MD
Saint-Petersburg State University Hospital,

Abhay Mahajan, MCh
Department of Urology, Mahatma Gandhi Mission’s Medical College and Hospital

Mohammed Taif Bendigeri, MCh
Asian Institute of Nephrology and Urology

Moisés Rodríguez Socarrás, MD
Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO

Thomas R.W. Herrmann, MD
. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG