大体积前列腺患者经尿道前列腺切除术（TURP）与铥激光汽化术（ThuVap）的疗效比较：一项真实世界研究

松井祐辉¹，朝仓聪¹，深贝隆志²

日立医疗中心¹，昭和医科大学²

Surgical Outcomes of Transurethral resection of the prostate (TURP) vs Thulium Laser Vaporization (ThuVap) in Large-Volume Prostates: A Real-world Comparative Study

Yuki Matsui¹, Satoshi Asakura¹, Takashi Fukagai²

Hitachi Medical Center¹, Showa Medical University School of medicine²

Introduction:

Transurethral resection of the prostate (TURP) has long been regarded as the gold standard surgical therapy for benign prostatic hyperplasia (BPH). In recent years, laser vaporization techniques have been increasingly adopted owing to reduced perioperative bleeding and shorter hospital stay.

Among these technologies, thulium laser vaporization (ThuVap) relies on water absorption and may have relatively limited hemostatic properties, despite its acknowledged vaporization efficiency. Comparative real-world evidence directly evaluating TURP and ThuVap modalities remains limited, particularly in prospective real-world settings.

Objective:

To compare perioperative safety and functional outcomes between ThuVap and TURP in a prospective single-center cohort of patients undergoing surgery for BPH.

Methods

We conducted a prospective comparative study including consecutive patients undergoing ThuVap (n=72) or TURP (n=64) for BPH at our institution. Patients were allocated to either procedure in a prospective comparative study manner based on procedural availability at the time of surgery. Baseline characteristics including prostate volume were collected preoperatively. Perioperative parameters and postoperative outcomes were compared between the two groups.

Evaluated endpoints included operative time, postoperative hemoglobin decrease, length of hospitalization, catheterization time, improvement in International Prostate Symptom Score (IPSS), quality of life score (QOL), maximum urinary flow rate (Qmax), and post-void residual volume (PVR). Complication profiles were assessed using Clavien–Dindo classification, focusing on postoperative bleeding, urinary retention, reoperation, urethral stricture, and urinary incontinence. Statistical significance was defined as p<0.05.

Results

Baseline characteristics were similar between the two groups. ThuVap significantly shortened the surgical time compared to TURP, and hospital stay and catheter placement duration were also significantly shorter with ThuVap. There were no significant differences in functional outcomes, including improvements in IPSS, QOL score, Qmax, and PVR. The incidence of complications and specific adverse events, such as postoperative hemoglobin levels, postoperative bleeding, urethral stricture, urinary incontinence, and reoperation, was similar between the two groups.

Conclusions

This prospective comparative study demonstrated that ThuVap and TURP provide comparable perioperative safety and functional outcomes.
ThuVap was associated with shorter operative time while maintaining similar catheterization duration, transfusion requirements, and symptom improvement.
Both techniques represent reliable surgical options for BPH, and the choice of procedure may be individualized based on patient characteristics and surgeon experience.