Presented by: Roman Andreev FACS
The S.I. Spasokukotsky City Clinical Hospital, Moscow, Russia

Introduction

Transurethral access is common in operations for prostatic adenoma. Transurethral monopolar and bipolar resection of the prostate have been the gold standard in the surgical treatment of prostatic adenoma for the past decades and are widely used by urologists around the world. However, patients undergoing transurethral electroresection of the prostate in the first weeks have hematuria, a pronounced pain syndrome and discomfort. In order to improve the results of surgical treatment of prostatic hyperplasia and improve the quality of life of patients, laser systems allowing to perform enucleation, vaporization and vapor resection of the prostate have been developed and introduced.

            The aim of the study: to evaluate the results of transurethral vaporesection of the prostate using the Thulium laser.

Materials

Patients had a transurethral vaporesection of the prostate using a Thulium laser. A 1000-micron fiber and the set power 200 W were used. The combination of laser type, fiber size and power allow high-speed resection of adenomatous tissue with minimal blood loss and excludes the possibility of TUR syndrome. In order to preserve the histological material during the surgical treatment of the patients by vaporization method we resected the prostatic adenoma sections of about 0,5-1 cm in size. The resected tissue was removed through the resectoscope tube using the evacuator. 

370 patients were operated on using this method. Such parameters as resection time, improvement of urine rate (Q max), post-void residual (PVR), International Prostate Symptom Scoring System (IPSS) and quality of life index (QoL) were assessed.

Results

,

The mean age of pateints was 67 years (46 to 98). The average prostate volume was 118.4 cm3.  The average time of vaporesection was 102 minutes. The duration of urethral catheter placement was 1.8 days. Qmax significantly improved from an average of 4.8 to 20.4 ml. PVR decreased from 94 to 17 ml. There were also improvements in IPSS from 20.1 to 6.2 and QoL from 4 to 1. No patient required hemotransfusions or repeated bladder drainage. 2 patients required the use of hemostatic drugs. Two patients required repeated hospitalization for surgical treatment of bladder neck sclerosis.

Conclusion

Evaluation of the results of laser vaporesection of the prostate using Thulium laser has shown high safety and efficiency of surgical treatment. This method allows to operate on patients with prostatic adenoma volumes over 150 cm3, also on patients taking anticoagulants for a long time, preserve histological material to exclude oncological process. The data of the 3-year follow-up showed significant improvements in the patients' quality of life and urinary symptoms. Longer follow-up and inclusion of more patients in the study are required to assess the persistence of the results.

Funding

no funding

Lead Authors

Konstantin Kolontarev, MD
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Dmitriy Pushkar, MD
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Co-Authors

Elena Lazareva, resident
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov