Feasibility of <i>en bloc</i> thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

doi:10.1016/j.ajur.2019.01.005

Asian Journal of Urology, 2019, 6 (4): 339-345 doi: 10.1016/j.ajur.2019.01.005

Original Articles

Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

Giovanni Saredi^a,Giacomo Maria Pirola^b,*(

),Francesca Ambrosini^a,Simone Barbieri^c,Lorenzo Berti^a,Andrea Pacchetti^d,Domenico Iovino^e,Giuseppe Ietto^e,Letizia Libassi^e,Giulio Carcano^e

^a Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
^b Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
^c Centro Cardiologico Monzino, IRCCS, Milan, Italy
^d Department of Urology, University of Genova, Genova, Italy
^e Department of Surgery, University of Insubria, Varese, Italy

Abstract
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Abstract

Objective: To provide the first large single-operator case series of patients who undergo “en bloc” thulium laser enucleation of the prostate (ThuLEP) and to demonstrate an improvement in enucleation efficacy with experience. Methods: We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent “en bloc” ThuLEP between May 2015 and November 2017. Association between dependent variables (delivered energy and operating time) and independent variables (adenoma volume and experience) were estimated with regression analysis. The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered. Results: A total of 100 patients were registered for the study. Median operative time was 56.5 min (interquartile range [IQR]: 40-85 min). Median enucleation time was 17.4 min (IQR: 15-21.5 min). Median enucleation index (enucleation time per adenoma gram) was 0.3 min/g (0.2-0.3 min/g). The overall operative time is not influenced by experience, but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram (p = 0.0148). Conclusion: We believe that further attention is needed for these new “en bloc” prostatic enucleation techniques, which can facilitate some surgical steps, leading to a widespread use of laser technology for BPH surgical treatment.

Key words： Benign prostatic hyperplasia Endoscopic enucleation of the prostate Laser surgery Thulium laser enucleation of the prostate

Received: 29 March 2018 Available online: 04 February 2019

Corresponding Authors: Giacomo Maria Pirola E-mail: gmo.pirola@gmail.com

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	Articles by authors
	Giovanni Saredi
	Giacomo Maria Pirola
	Francesca Ambrosini
	Simone Barbieri
	Lorenzo Berti
	Andrea Pacchetti
	Domenico Iovino
	Giuseppe Ietto
	Letizia Libassi
	Giulio Carcano

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Cite this article:

Giovanni Saredi,Giacomo Maria Pirola,Francesca Ambrosini, et al. Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?[J]. Asian Journal of Urology, 2019, 6(4): 339-345.

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http://www.ajurology.com/EN/10.1016/j.ajur.2019.01.005 OR http://www.ajurology.com/EN/Y2019/V6/I4/339

Baseline patients'characteristics.

Intraoperative characteristics and outcomes of the whole patients' series presented in the study.

Analysis of the surgical complications occurred in our series within 30-day perioperative period. Results are reported according to the modified Clavien Grade [8].

Intraoperative characteristics and outcomes comparison between the three tertiles of experience (low, medium and high experience).

The odds ratio (OR) shows that there is 80% less probability of a high energy delivery for medium and high experience compared to the first tertile (low experience). TERZ, tertile; OR1, first tertile of experience; OR2, second tertile of experience; OR3, third tertile of experience.

ROC curves of the statistical model utilized to describe the effect of experience on the reduction of the total amount of energy, and consequently on the enucleation efficacy. The area under the curve (AUC) is significatively high (0.783). ROC, receiver operating characteristic.

Follow-up on functional results at 6 months after surgery.

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