銩鐳射前列腺剜除手術(Vela^TM XL)與雙極經尿道前列腺剜除手術(B-TUEP)的療效及生活品質之比較

陳昱廷、侯鎮邦、林友翔、陳建綸、楊佩珊、崔克宏、張慧朗

林口長庚紀念醫院 外科部泌尿科

Comparison of Thulium laser (Vela^TM XL) enucleation of prostate with bipolar transurethral enucleation of the prostate (B-TUEP) of outcome and quality of life

Yu-Ting Chen, Chen-Pang Hou, Yu-Hsiang Lin, Chien-lun Chen, Pei-Shan Yang, Ke-Hung Tsui, Phei-Lang Chang

Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Purpose:

For decades, transurethral resection of the prostate (TURP) has been the gold standard in surgical treatment for lower urinary tract symptoms secondary to BPH. While improvements in transurethral resection of the prostate (TURP) instruments have reduced complications, high recurrence rate remains a concern. In light of this, new surgical techniques such as endoscopic enucleation was developed to overcome these issues. We reported our patient outcomes with technique of 120W Thulium laser (Vela™ XL) prostate enucleation (ThuLEP) compared to bipolar transurethral enucleation of the prostate (B-TUEP).

Materials and Methods:

We excluded patients who had concomitant prostate cancer, bladder cancer. After exclusion, we prospectively analyzed 111 patients with BPH who underwent ThuLEP and B-TUEP by a single surgeon since Oct 2018 to Jan 2020. The peri-operative outcomes were evaluated including blood loss, prostate resection percentage of transition zone, postoperative pain score (Numeric Rating Scale, NRS), complication, changes in postoperative urodynamics, IPSS, and PSA, and the rate of reuse of BPH medications. To precisely estimate the blood loss, we used the concept of equivalent solute mass by measuring the volume and the hematocrit of the irrigating fluid and the hematocrit of the preoperative blood. The equation is as below: Calculated blood loss = hematocrit in the diluting fluid × irrigating fluid volume ÷ pre-operative blood hematocrit.

Results:

The patients’ demographics, pre-operative prostate volumes, PSA and IPSS were comparable between the groups. Our results revealed that ThuLEP and B-TUEP had no significant difference in operation time (84.5 min and 77.7 min, p=0.241), resected prostate tissue (70.4% and 70.7%, p=0.957), days of hospitalization (2.1 days and 2.5 days, p=0.118). However, ThuLEP compared to B-TUEP had less intraoperative blood loss (82.4ml and 199.2ml, respectively, p<0.001), less postoperative pain(p<0.001), and B-TUEP was associated with more postoperative complications such as postoperative urinary tract infection and urinary retention or hematuria. No significance difference between the groups of changes in uroflow study, IPSS at the follow-up timing of post-operation 2 weeks, 3 months, and 6 months except residual urine amount at 6 months (-38.5ml, -115.5ml, p=0.011).

Conclusion:

As compared to bipolar transurethral enucleation of the prostate, the Thulium laser prostate enucleation has the advantages of less blood loss and less post-operative pain, and the clinical outcomes are comparable between the groups.