Presented by: P. Walker Prillaman MD
Urology of Virginia

Introduction

Laser enucleation of the prostate is an effective and durable endoscopic procedure for BPH. While Holmium and Thulium enucleation are considered standards of care for large glands, this study sought to investigate the 1470nm Diode laser with adenomas >150 gm. We hypothesize that DiLEP will yield similar outcomes with a similar side effect profile.

Materials

A retrospective review of one surgeon’s experience with DiLEP was conducted in men undergoing surgery from Oct 2016 to Apr 2022. Pre-op variables included prostate size and prior BPH procedure. Peri-op variables included operative time, enucleation weight, presence of cancer, length of stay, and transfusion rate. We assessed post-op complications and need for further procedures. We compared pre to post-op PVR, retention rates, and IPSS and QOL scores at pre-op, 1 month, 3 months, and 12 months post-op.

Results

,

71 men were identified for inclusion. Mean follow-up was 17.7 (SD 13.5) months. Mean operative time was 143.2 (SD 48.2) minutes. The average enucleation weight (pathologist reported) was 93.6 (SD 45.0) grams, with a mean prostate size of 216.0 (SD 52.1) grams.  Mean hospital stay was 1.28 (SD 2.0) days. 2 patients (2.8%) required a transfusion.  3 patients (4.2%) were found to have prostate cancer. 6 patients (8.5%) had undergone a prior BPH procedure, while 3 (4.2%) required a subsequent surgery. 8 patients experienced a significant post-op complication, notable for 3 requiring clot evacuation, 1 with urosepsis, 2 DVTs, and 1 CVA. Mean IPSS score at the pre-op, 1 month, 3 month, and 12 month post-op mark were 15.5 (SD 8.64), 8.2 (SD 5.8), 5.7 (SD 4.7), and 3.9 (SD 3.4), respectively. Similarly, QOL scores were 3.9 (SD 1.4), 2.6 (SD 1.5), 2.0 (SD 1.7), and 1.9 (SD 1.4) respectively. The mean pre-op PVR was 396.7 cc (SD 369.9) compared to post-op of 64.5 cc (SD 66.7). While 64.8% of patients experienced retention pre-op, only 3.2% experienced it post-op.

Conclusion

To our knowledge this is the largest reported 1470nm DiLEP series with the largest mean prostate size.  With favorable hemostatic and depth of penetration qualities (~ 1mm), the 1470nm Diode laser appears to be a safe and effective energy modality for enucleation.  DiLEP is reported here to have similar complication rates and improvements in IPSS and QOL scores compared to those previously reported for HoLEP and ThuLEP. Longer follow-up will be useful in demonstrating its durability. Randomized trials will be the next step to assess if DiLEP should be considered a standard of care for large glands.

Funding

None

Lead Authors

Douglas Kelly, MD
Urology of Virginia