Transurethral Thulium Laser Prostatectomy in the Outpatient Setting: Benefits and Outcomes at a Single Center in the United States
Curran Uppaluri, BS; Theodore Cisu, BS; David Sobel, MD; Richard Grunert, MD FACS.
University Of Vermont, Burlington, VT
INTRODUCTION AND OBJECTIVES:
Thulium laser prostatectomy is a versatile laser that allows for vaporization, vapo-enucleation and enucleation and morcellation of benign prostatic hyperplasia (BPH). In an effort to seek out procedures to avoid inpatient hospitalization while maintaining superior hemostasis, this study details the ongoing experience utilizing thulium laser vaporization in the outpatient setting.
A retrospective chart review of patients who underwent thulium laser vapo-enucleation between 2014 and 2018 was performed. AUA symptom scores, PSA reduction, duration of catheterization, and postoperative complications were analyzed. All procedures were performed by a single surgeon at a single institution utilizing 150 watt and later a 200 watt laser for surgery.
128 patients were included in the analysis. 11 patients were anticoagulated and 9 patients had concurrent cystolithalopaxies performed. 25 patients had repeat procedures from prior TURPs or green light laser prostatectomies. Of the primary cases, the mean prostate size was 56 gm (range 15-167gm). 121 (95%) patients were able to be discharged as outpatients the day of surgery. The mean preoperative AUA symptom scores, generally on maximal medical therapy, were 19.1 and 16.8 for primary and repeat, respectively. The mean AUA symptom scores were significantly reduced to 6.1 and 8.2 (p < 0.005 for both), respectively, at 3-month follow-up (128 pts) and further reduced to 5.1 and 6.0 (p < 0. 005 for both), respectively, at 12-month follow-up (71 pts) and 6.0 ( p < 0.0001) at 24 months (37 pts). For primary patients, the mean preoperative PSA was 4.1 ng/mL (range 0.2-37.0) and the postoperative PSA was 1.5 ng/mL (63.4% reduction; range 0.1-10.3). Ejaculatory function was preserved in 65 patients (57.8%) and worsening erectile function occurred with 12 patients (10.2%). Transient short-term stress incontinence occurred in 5 patients and resolved in all. 2 patients required a repeat resection and 1 patient had a bladder neck contracture. 57 patients (46.2%) required two or fewer days of postop catheterization, with a mean of 2.8 days (range 0-14 days). 20 patients (15.6%) experienced problematic postoperative hematuria after discharge, of which 7/11 anticoagulated patients passed significant clots requiring catheterization. 5/117 of patients overall (4.3%) went into clot retention requiring delayed admission and continuous bladder irrigation.
Our experience suggests that thulium laser vaporization of the prostate is a safe, effective and durable alternative for the treatment of BPH with results comparable to published traditional inpatient electrosurgical methods. Our analysis suggest that effective laser therapy offers an advantage by greatly reducing the need for hospitalization without compromising efficacy of traditional electrosurgical methods.
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