Thulium laser (RevoLix) vaporesection versus vapoenucleation with morcellator (Piranha) for the treatment of benign prostatic obstruction: A propensity-matched multicenter analysis

• Published in: International journal of urology Vol. 21; no. 11; pp. 1156 - 1161
• Main Authors: Chung, Jae Seung, Kang, Pil Moon, Seo, Won Ik, Oh, Cheol Kyu, Kim, Seong Cheol, Park, Sang Hyun, Choi, Jun Ho, Yoon, Jang Ho, Kang, Dong Il, Chung, Jae Il
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-11-2014
• Subjects: Aged; Aged, 80 and over; Humans; laser therapy; Laser Therapy - adverse effects; Laser Therapy - instrumentation; Laser Therapy - methods; Laser Therapy - statistics & numerical data; Lasers, Solid-State - therapeutic use; Male; Middle Aged; Propensity Score; prostatatic hyperplasia; Prostatectomy - adverse effects; Prostatectomy - instrumentation; Prostatectomy - methods; Prostatectomy - statistics & numerical data; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - surgery; Retrospective Studies; Thulium; Urinary Retention - etiology; Urinary Retention - surgery; vapoenucleation; vaporesection; thulium; vaporesection; vapoenucleation; prostatatic hyperplasia; laser therapy
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.12547

Objectives
To compare the efficacy and safety of vaporesection without a morcellator, and vapoenucleation with a morcellator in thulium laser prostatectomy for the treatment of benign prostatic obstruction.
Methods
Between March 2010 and January 2013, 405 patients underwent thulium:yttrium‐aluminium‐garnet laser prostatectomy. Among these patients, 150 patients who underwent thulium:yttrium‐aluminium‐garnet laser prostatectomy without a morcellator (n = 75) or with a morcellator (n = 75) were analyzed in a propensity matching study. Outcome measures included International Prostate Symptom Score, quality of life score, maximum flow rate, postvoid residual, total operating time, laser time and resected tissue weight.
Results
No significant differences were noted between the thulium:yttrium‐aluminium‐garnet laser prostatectomy without a morcellator and thulium:yttrium‐aluminium‐garnet laser prostatectomy with a morcellator groups, including the prostate volume (50.3 vs 51.9 mL) and postoperative prostate volume (22.4 vs 18.7 mL). However, there were differences between the groups in total operating time (72.8 vs 61.0 min, P = 0.023) and laser activating time (24.5 vs 19.9 min, P = 0.037). Thulium:yttrium‐aluminium‐garnet laser prostatectomy with a morcellator showed greater resected tissue volume than thulium:yttrium‐aluminium‐garnet laser prostatectomy without a morcellator (9.0 vs 18.2 g, P = 0.029). There were also significant differences in total retrieval efficiency (1.14 vs 1.67 g/min, P = 0.031). There were no significant differences in improvement of International Prostate Symptom Score, quality of life scores and urodynamic findings between the two groups, except for the International Prostate Symptom Score (11.2 vs 7.3, P = 0.028) at 6 weeks after surgery.
Conclusion
Thulium:yttrium‐aluminium‐garnet laser prostatectomy with a morcellator provides superior reduction of prostate volume and better short‐term clinical outcomes than thulium:yttrium‐aluminium‐garnet laser prostatectomy without a morcellator in the treatment of patients with benign prostatic obstruction. Furthermore, thulium:yttrium‐aluminium‐garnet laser prostatectomy with a morcellator can offer a shorter operative time.