Thulium YAG laser versus bipolar enucleation for management of benign prostate obstruction secondary to large prostates (>80 gm): A multicenter prospective randomized study

TL;DR

This study compares two surgical methods for treating large benign prostates and finds similar outcomes in terms of effectiveness and complications.

Contribution

The study provides a direct comparison of THuLEP and BEEP for large prostates (>80 gm), offering insights into their respective complication rates and functional outcomes.

Findings

Both THuLEP and BEEP showed comparable improvement in IPSS score, Q max, and PVR postoperatively.

THuLEP had higher rates of urgency and stress urinary incontinence at 1 month compared to BEEP.

Incontinence rates improved in both groups by 3 months, with some persistent cases in THuLEP after 1 year.

Abstract

Endoscopic enucleation of the prostate (EEP) was introduced to treat patients with large prostate. The study compared the perioperative and post-operative outcomes of bipolar current and Thulium-YAG in endoscopic enucleation of large prostates above 80 gm.

This is a prospective study conducted on 120 male patients. The patients were randomized into two equal groups; Group A Thulium laser enucleation of the prostate (THuLEP) and Group B bipolar enucleation of the prostate (BEEP). All patients were preoperatively evaluated as regards operative time, hemoglobin drop, intraoperative and early postoperative complications, hospital stay, and time of catheter removal. Patients were then followed up at 1, 3, 6, and 12 months to detect urinary and sexual functional outcome and any postoperative complications.

The preoperative characteristics of both groups were comparable. The mean prostate volume was 122.33 ± 24.34 (84–180 gms) and 120.88 ± 25.66 (85-180gms) (p value: 0.751) in THuLEP and bipolar groups, respectively. Significant comparable improvement in IPSS score, Q max, and PVR postoperatively was found in both groups at all follow up points. Follow up after 1 month revealed urgency urinary incontinence in 34 (56.7%) cases in THuLEP and 14 (23.3%) cases in bipolar enucleation group (p value 0.001), and stress urinary incontinence was detected in 44 (73.3%) cases in THuLEP and 26 (43.3%) cases in bipolar enucleation group, respectively (p value 0.001). Both types of incontinence improved after 3 months in both groups, three cases in the THuLEP group had persistent stress incontinence after 1 year.

ThuLEP and bipolar enucleation are comparable treatment modalities for patients with large prostate (>80 ml).

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