Comparing surgical techniques: ThuLEP and transurethral BPEP for prostate over 80 grams. Intraoperative and postoperative results. A prospective randomized trial.
Samer Morsy, Mahmoud Elfeky, Sherif Abdel-Rahman, Hesham Torad, Ahmed Rammah, Mina Safwat
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Abstract
Background and purpose: Though TURP remains the primary treatment for BPH, advancements in energy and technology have introduced innovative transurethral surgical options. In this study, we assessed and compared the effectiveness and safety of using thulium laser and bipolar for endoscopic enucleation of prostate exceeding 80 g.
Patients and methods: Between January 2022 and July 2023, this study enrolled patients with LUTS due to BPH and a prostate size of ≥80 g. Group A underwent the BPEP procedure using a 26 Fr continuous flow resectoscope with plasma kinetic system enucleation loops, while Group B underwent the ThuLEP procedure using a 120-200 W Revolix DUO® Thulium laser. Data collection included prostate size, PSA levels, enucleation and morcellation time, and postoperative IPSS and IIEF-5 scores at one, 3, 6, and 12 months.
Results: A total of 108 patients, divided into Group A (BPEP) and Group B (ThuLEP), completed a 12-month follow-up. The mean age for group A was 67.72 ± 7.02 compared to group B which was 62.33 ± 5.86. While Group A compared to group B had higher mean enucleation (75.22 ± 10.55 vs. 67 ± 12.18) and total operative times (117.22 ± 17.76 vs.90.5 ± 18.29) (p = 0.037 & <0.001 respectively), no significant differences were observed in resected tissue weight, blood transfusion, and morcellation time. The ThuLEP group exhibited a shorter mean catheter period 2.94 ± 0.94 d compared to BPEP 3.33 ± 0.91 d and shorter mean hospital stay period of 1.94 ± 0.54 compared to2.11 ± 0.32, though not statistically significant. Postoperative outcomes, including IPSS, Qmax, PVRU, and IIEF-5 at 1, 3, 6, and 12 months, showed no differences between the groups.
Conclusion: ThuLEP shows better perioperative parameters in comparison to BPEP. Nevertheless, there are no notable differences in functional results and complications between the two techniques.
期刊介绍：
The Arab Journal of Urology is a peer-reviewed journal that strives to provide a high standard of research and clinical material to the widest possible urological community worldwide. The journal encompasses all aspects of urology including: urological oncology, urological reconstructive surgery, urodynamics, female urology, pediatric urology, endourology, transplantation, erectile dysfunction, and urinary infections and inflammations. The journal provides reviews, original articles, editorials, surgical techniques, cases reports and correspondence. Urologists, oncologists, pathologists, radiologists and scientists are invited to submit their contributions to make the Arab Journal of Urology a viable international forum for the practical, timely and state-of-the-art clinical urology and basic urological research.
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