Thulium Enucleation of Prostate

Abstract

The thulium laser has several properties that confer some theoretical advantages over other lasers used for the treatment of BPH such as a relatively small zone of thermal damage. In ex vivo animal studies comparing the KTP and thulium lasers, similar hemostatic properties were observed with a shallower coagulation zone (Wendt-Nordahl et al. J Endourol. 2008;22:1041). Two main techniques for laser resection and vapoenucleation have been described: ThuVEP and TmLRP (Xia et al. Eur Urol. 2008;53:383, Bach et al. World J Urol. 2007;25:257). Studies using the 70–120-W thulium laser systems demonstrate good efficacy of these procedures with low morbidity and few complications in mostly small- and medium-sized prostates (Gross et al. Eur Urol. 2012;63:859). Safety and efficacy has also been demonstrated in patients taking oral anticoagulation (Macchione et al. Int Urol Nephrol. 2013;45:1545–51). Comparative studies have been published comparing thulium laser prostatectomy to monopolar TURP, bipolar TURP, and HoLEP. Compared to all these techniques, thulium laser prostatectomy had a longer operative time and demonstrated superior blood loss compared to TURP techniques. Short- and intermediate-term improvements in IPSS, QoL, Qmax, and PVR were similar across techniques. Overall thulium laser resection and vapoenucleation, and enucleation techniques appear safe and effective with low morbidity. Further comparative and long-term studies are needed for this promising technology, particularly in larger prostates.