Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction
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Transurethral removal of prostatic tissue is the treatment choice for benign prostatic enlargement and benign prostatic obstruction. Urodynamic results are directly linked to the amount of removed tissue which, however, is directly associated with intra- and postoperative morbidity. Transurethral laser operations of the prostate offer the advantage of decreased bleeding complications and the possibility to treat patients with bleeding disorders or anticoagulative treatment. The aim of the article is to present a novel technique of complete transurethral removal of the transition zone (enucleation) with the support of the Thulium laser to combine complete anatomical enucleation and maximum urodynamic efficacy with minimal side-effects.
Materials and methods
We present five distinct surgical steps for transurethral complete removal of the transition zone of the prostate (Thulium laser enucleation of the prostate, ThuLEP). Surgical steps are presented in chronological order with the help of intraoperative pictures. Laser energy of 70–90 W is only used for the incision at the verumontanum and bladder neck for removal of the middle lobe, whereas laser energy of 30 W was only used for coagulation of small vessel crossing the surgical capsule towards the transition zone and bladder neck for dissection of the lateral lobes. The lobes themselves are liberated by blunt dissection.
ThuLEP offers complete removal of the transition zone no matter what prostatic size. The techniques combine maximum efficacy with minimal side-effects. Clinical results comparing ThuLEP with open prostatectomy or transurethral resection are awaited.
KeywordsBenign prostatic enlargement Benign prostatic obstruction Treatment Laser prostatectomy Thulium Holmium HoLEP
Conflict of interest statement
There is no conflict of interest.
- 2.Tan AH, Gilling PJ, Kennett KM et al (2003) A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol 170:1270CrossRefPubMedGoogle Scholar
- 4.Bach T, Wezel F, Haecker A, Gross AJ, Michel MS (2009) 70 vs 120 W thulium:yttrium-aluminiumgarnet 2 m continuous-wave laser for the treatment of benign prostatic hyperplasia: a systematic ex-vivo evaluation. BJU [Epub ahead of print]. doi: 10.1111/j.1464-410X.2009.09059.x
- 10.Bach T, Netsch Ch, Haecker A, Michel MS, Herrmann TRW, Gross AJ (2009) Thulium:YAG laser enucleation (VapoEnucleation) of the prostate: safety and durability during intermediate-term follow-up. World J Urol [Epub ahead of print]Google Scholar
- 11.Imkamp F, Bach T, Gross AJ, Kuczyk MA, Herrmann TR (2009) ThuLEP—Thulium laser enucleation of the prostate. J Endourol 23(Suppl 1):24Google Scholar
- 12.McConnel JD, Barry MJ, Bruskewitz RC et al (1994) Benign prostatic hyperplasia: diagnosis and treatment. Clinical Practice Guideline, Number 8. Chapters 10-14. US: Department of Health and Human Services, Public Health Service, Agency for Health Care policy and researchGoogle Scholar
- 13.Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG (2008) Urology Section of the Bavarian Working Group for Quality Assurance. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180(1):246–249CrossRefPubMedGoogle Scholar
- 21.Wendt-Nordahl G, von Löwenstern K, Honeck P et al (2008) Ex-vivo comparison of bipolar plasma-kinetic vaporization of the prostate to low power and high power Greenlight laser. J Endourol 22(Suppl 1): A19, BR4–14Google Scholar
- 22.Bach T, Wezel F, Haecker A, Gross AJ, Michel MS (2009) 70 vs 120 W thulium:yttrium-aluminiumgarnet 2 m continuous-wave laser for the treatment of benign prostatic hyperplasia: a systematic ex-vivo evaluation. BJU [Epub ahead of print]. doi: 10.1111/j.1464-410X.2009.09059.x
- 27.Elmansy HM, Elzayat EA, Sampalis JS, Elhilali MM (2009) Prostatic-specific antigen velocity after holmium laser enucleation of the prostate: possible predictor for the assessment of treatment effect durability for benign prostatic hyperplasia and detection of malignancy. Urology 74(5):1105–1110CrossRefPubMedGoogle Scholar