Introduction and objectives:
To compare thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic hyperplasia (BPH) with a 24-month follow-up.
Methods:
94 patients with symptomatic BPH were randomized to ThuVEP (n=48) or HoLEP (n=46). All patients were assessed preoperatively and followed at 1, 6, 12, and 24 months postoperatively. International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), and PSA were obtained at each follow-up visit. The perioperative complications were classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%).
Results:
There were no significant differences between the surgical groups pre-operatively: median age at surgery was 73 (67-76) yrs. and prostate volume was 80 (46.75-100) gm. Fourty-three (45.7%) patients presented in urinary retention with an indwelling catheter. The operative time was 60 (41-79) minutes without differences between the groups. There were no differences between the groups regarding catheter time (2 (2-2) days) and postoperative stay (2 (2-3) days). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without differences between the groups. At 12-month follow-up, Qmax (10.7 vs. 23.3 ml/s), PVR (100 vs. 11.1 ml), IPSS (20 vs. 5), and QoL (4 vs. 1) differed significantly from baseline (p<0.001) without differences between the groups. A significant decrease of median PSA was found at 24-month (4.14 vs. 0.46 µg/l) follow-up (p<0.001) corresponding to a PSA-decrease of 81.8 (67.5-94.1)% without differences between the groups. At 24-month follow-up, Qmax (10.7 vs. 22.8 ml/s), PVR (100 vs. 22 ml), IPSS (20 vs. 5), and QoL (4 vs. 1) had still improved significantly compared to baseline (p<0.001). However, median PVR was significantly lower after HoLEP (12.5 ml) compared to ThuVEP (29.9 ml) (p≤0.03). The reoperation rate was zero at 24-month follow-up. During 24-month follow-up, two episodes (2.1%) of acute urinary retention occurred and 7 (7.4%) patients developed urinary tract infections without differences between the groups.
Conclusions:
ThuVEP and HoLEP are safe and effective procedures for the treatment of symptomatic BPH. Both procedures give equivalent and satisfactory micturition improvement with low morbidity and durable prostate volume reduction at 24-month follow-up.
Source of Funding:
Boston Scientific: ISRURO400001
