Abstract: PD23-06
Sources of Funding: Boston Scientific (#ISRURO400001)

Introduction

To compare the 6-month outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO).

Methods

A prospective randomized trial comparing ThuVEP with HoLEP was conducted from February 2015 to February 2016 at the Asklepios Klinik Barmbek. A total of 94 patients with symptomatic BPO were prospectively randomized to ThuVEP (n=48) or HoLEP (n=46). All patients were assessed preoperatively by International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), PSA, and prostate volume measurement by transrectal ultrasound. The patients were reassessed with the same tests at 1-month and 6-month follow-up. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%).

Results

There were no statistically significant differences in any baseline characteristics between the groups. Median age at surgery was 73 (67-76) yrs. and median prostate volume was 80 (46.75-100) cc. 43 (45.7%) patients presented in urinary retention with an indwelling catheter. The median operative time was 60 (41-79) minutes without significant differences between the groups. There were no significant differences between the groups regarding catheter time (2 (2-2) days) and postoperative stay (2 (2-3) days). Clavien 1 (13.8%), 2 (3.2%), 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was significantly higher after HoLEP compared to ThuVEP (15.2% vs. 2.1%, p≤0.022) at 4-week follow-up. At 6-month follow-up, median Qmax (10.7 vs. 25.9 ml/s), PVR (100 vs. 6.5 ml), IPSS (20 vs. 5), QoL (4 vs. 1), PSA (4.14 vs. 0.71 μg/l), and prostate volume (80 vs. 16 ml) had improved significantly (p<0.001) compared to baseline without differences between the groups. The median PSA decrease was 79.7% (58.8-90.6%) and the median prostate volume reduction was 74.5% (68.57-87.63%) without differences between the groups. The reoperation rate was zero at 6-month follow-up.

Conclusions

ThuVEP and HoLEP are both safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory micturition improvement with low morbidity and sufficient prostate volume reduction at 6-month follow-up.

Funding

Boston Scientific (#ISRURO400001)