Presented by: Vladislav Petov MD
Institute for Urology and Reproductive Health, Sechenov University

Introduction

To date, long-term outcomes of endoscopic enucleation of the prostate (EEP) remain understudied. The objective of our study was to analyze the long-term efficacy and safety of holmium and thulium fiber laser enucleation of the prostate (HoLEP and ThuFLEP).

Materials

We performed a retrospective analysis of data collected during the period from 2013 to 2021. Inclusion criteria: patients after HoLEP or ThuFLEP performed for severe LUTS (IPSS > 20 and/or Qmax < 15 ml/s). Efficiency was evaluated according to functional outcomes, post-void residual urine (PVR), Qmax, IPSS and QoL; safety - by the frequency of early and late postoperative complications.

Results

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The data on 2390 patients was collected; 127 from the HoLEP group and 1328 from the ThuFLEP group were included to the final analyses. The functional outcomes of HoLEP after 3 years are as follows: PVR - 31.4±11.7 ml, Qmax 21.8±5.4 ml/s, IPSS 5.9±2.4, QoL 1.6±1.2; after ThuFLEP: PVR - 18.2±20.1 ml, Qmax 21.6±5.7 ml/s, IPSS 4.1±2.0, QoL 1.3±1.1. In the early postoperative period (<3 months), the following I-II Clavien-Dindo complications were detected: transient urinary incontinence (5.5% after HoLEP and 9.7% after ThuFLEP), clot retention (7.8% each in both groups), urinary tract infections (3.9% and 2.5%), injury of the bladder wall (1.6% and 0.3%) and injury of the ureteral orifice (0.8% and 0.3%). The frequency of grade III or higher complications according to Clavien-Dindo: acute urinary retention (HoLEP - 6.3%, ThuFLEP - 3.7%), clot retention with surgical revision (4.7% and 0.8%), incomplete morcellation (3.9% and 1.1%). Late complications were detected in 3.6% of patients: urethral stricture - in 2.4% (HoLEP) and 1.1% (ThuFLEP), bladder neck contracture - 1.6% and 0.9%, stress urinary incontinence for more than 6 months - in 1.6% and 1.2%.

Conclusion

EEP is an effective method in the long term elimination of LUTS related to BPO, regardless of the source of energy. Both early and late postoperative results, as well as the number of complications are satisfactory irrespective of the type of enucleation (HoLEP, ThuFLEP).

Funding

None.

Lead Authors

Dmitry Enikeev, MD, PHD, professor
Department of Urology, Medical University of Vienna

Co-Authors

Diana Babaevskaya, MD
Institute for Urology and Reproductive Health, Sechenov University

Mark Taratkin, MD
Institute for Urology and Reproductive Health, Sechenov University

Aleksandr Androsov,
Institute for clinical medicine, Sechenov University

Andrey Morozov, MD, PHD
Institute for Urology and Reproductive Health, Sechenov University