Thulium Laser Vaporization versus Vapoenucleation (without morcellation) Technique for BPH: Do We Have a Winner?

Background and ObjectiveThe thulium laser surgery is a relatively new approach in which a wavelength of approximately 2 μm is emitted in continuous-wave mode, thus enabling the precise incision of tissue by using a wavelength that matches the water absorption peak of 1.92 μm in tissue. However, no published multinational study or other evidence definitively declares the superiority of thulium vaporization (ThuVAP) over thulium vapoenucle-ation (ThuVEP) without morcellator for better management of bothersome benign prostatic hyperplasia. The present study aims to evaluate the efficacy of vaporization and vapoenucleation (without a morcellator) in thulium laser prostatectomy for the treatment of benign prostatic hyperplasia.MethodsA retrospective analysis of 82 patients who underwent thulium laser prostatectomy between February 2017 and January 2018 with ThuVAP and ThuVEP techniques was done and outcome measures analyzed were International Prostate Symptom Score (IPSS), quality-of-life score (QoL), maximum flow rate (Q max), post-void residual (PVRU), total operating time, laser time and resected tissue weight.ResultsNo significant differences were noted between ThuVAP and ThuVEP in terms of post-operative prostate volume (22.4 vs. 21.7 mL) and post-operative prostate specific antigen (PSA) (2.54 vs. 1.85 ng/mL). Nonetheless, there were differences between the groups in total lasing time (56.5 vs. 44.8 min, p = 0.001) and total operative time (88.5 vs. 71.5 min, p= 0.001). There was also a significant difference in IPSS, QoL score, Q max, and PVRU at 6 weeks, 3 months, 6 months and 9 months after surgery.