World Journal of Urology

, Volume 28, Issue 1, pp 45–51 | Cite as

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

  • Thomas R. W. HerrmannEmail author
  • T. Bach
  • F. Imkamp
  • A. Georgiou
  • M. Burchardt
  • M. Oelke
  • A. J. Gross
Topic Paper



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.


Benign prostatic enlargement Benign prostatic obstruction Treatment Laser prostatectomy Thulium Holmium HoLEP 


Conflict of interest statement

There is no conflict of interest.


  1. 1.
    Herrmann TR, Georgiou A, Bach T, Gross AJ, Oelke M (2009) Laser treatments of the prostate vs TURP/open prostatectomy: systematic review of urodynamic data. Minerva Urol Nefrol 61(3):309–324PubMedGoogle Scholar
  2. 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
  3. 3.
    Fried NM, Murray KE (2005) High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol 19(1):25–31CrossRefPubMedGoogle Scholar
  4. 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
  5. 5.
    Bach T, Herrmann TR, Cellarius C, Gross AJ (2007) Bladder neck incision using a 70 W 2 micron continuous wave laser (RevoLix). World J Urol 25(3):263–267CrossRefPubMedGoogle Scholar
  6. 6.
    Bach T, Herrmann TR, Ganzer R, Gross AJ (2007) RevoLix™ vaporesection of the prostate: initial results after 54 patients with an one-year follow-up. World J Urol 25(3):257–262CrossRefPubMedGoogle Scholar
  7. 7.
    Bach T, Herrmann TR, Ganzer R, Blana A, Burchardt M, Gross AJ, Urologe A (2009) Thulium:YAG vaporesection of the prostate: first results. Urologe A 48(5):529–534CrossRefPubMedGoogle Scholar
  8. 8.
    Bach T, Wendt-Nordahl G, Michel MS, Herrmann TR, Gross AJ (2009) Feasibility and efficacy of Thulium: YAG laser enucleation (VapoEnucleation) of the prostate. World J Urol 27(4):541–545CrossRefPubMedGoogle Scholar
  9. 9.
    Bach T, Herrmann TR, Haecker A, Michel MS, Gross A (2009) Thulium:yttrium-aluminium-garnet laser prostatectomy in men with refractory urinary retention. BJU Int 104(3):361–364CrossRefPubMedGoogle Scholar
  10. 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. 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. 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. 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
  14. 14.
    Holtgrewe HL, Valk WL (1962) Factors influencing the mortality, morbidity of transurethral prostatectomy: a study of 2, 015 cases. J Urol 87:450PubMedGoogle Scholar
  15. 15.
    Melchior J, Valk WL, Foret JD, Mebust WK (1974) Transurethral prostatectomy: computerized analysis of 2,223 consecutive cases. J Urol 112:634PubMedGoogle Scholar
  16. 16.
    Mebust WK, Holtgrewe HL, Cockett AT, Peters PC (1989) Transurethral prostatectomy: immediate and postoperative complications: A cooperative study of 13 participating institutions evaluating 3, 885 patients. J Urol 141:243–247PubMedGoogle Scholar
  17. 17.
    Hiraoka Y, Akimoto M (1989) Transurethral enucleation of benign prostatic hyperplasia. J Urol 142(5):1247–1250PubMedGoogle Scholar
  18. 18.
    Fraundorfer MR, Gilling PJ (1998) Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 33(1):69–72CrossRefPubMedGoogle Scholar
  19. 19.
    Teichmann HO, Herrmann TR, Bach T (2007) Technical aspects of lasers in urology. World J Urol 25(3):221–225CrossRefPubMedGoogle Scholar
  20. 20.
    Wendt-Nordahl G, Huckele S, Honeck P, Alken P, Knoll T, Michel MS, Häcker A (2008) Systematic evaluation of a recently introduced 2-microm continuous-wave thulium laser for vaporesection of the prostate. J Endourol 22(5):1041–1045CrossRefPubMedGoogle Scholar
  21. 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. 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
  23. 23.
    El-Hakim A, Elhilali MM (2002) Holmium laser enucleation of the prostate can be taught: the first learning experience. BJU Int 90(9):863–869CrossRefPubMedGoogle Scholar
  24. 24.
    Tinmouth WW, Habib E, Kim SC, Kuo RL, Paterson RF, Terry CL, Elhilali M, Lingeman JE (2005) Change in serum prostate specific antigen concentration after holmium laser enucleation of the prostate: a marker for completeness of adenoma resection? J Endourol 19(5):550–554CrossRefPubMedGoogle Scholar
  25. 25.
    Ozden C, Inal G, Adsan O, Yazici S, Ozturk B, Cetinkaya M (2003) Detection of prostate cancer and changes in prostate-specific antigen (PSA) six months after surgery for benign prostatic hyperplasia in patients with elevated PSA. Urol Int 71:150CrossRefPubMedGoogle Scholar
  26. 26.
    Aus G, Bergdahl S, Frösing R, Lodding P, Pileblad E, Hugosson J (1996) Reference range of prostatespecific antigen after transurethral resection of the prostate. Urology 47:529CrossRefPubMedGoogle Scholar
  27. 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
  28. 28.
    van Iersel MP, Thomas CM, Witjes WP, de Graaf R, de la Rosette JJ, Debruyne FM (1996) Clinical implications of the rise and fall of prostate specific antigen after laser prostatectomy. Br J Urol 78:742PubMedGoogle Scholar
  29. 29.
    Hai MA, Malek RS (2003) Photoselective vaporization of the prostate: Initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia. J Endourol 17:93CrossRefPubMedGoogle Scholar
  30. 30.
    Te AE, Malloy TR, Stein BS et al (2004) Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial. J Urol 172:1404CrossRefPubMedGoogle Scholar
  31. 31.
    Hamann MF, Naumann CM, Seif C, van der Horst C, Jünemann KP, Braun PM (2008) Functional outcome following photoselective vaporisation of the prostate (PVP): urodynamic findings within 12 months follow-up. Eur Urol 54(4):902–907CrossRefPubMedGoogle Scholar
  32. 32.
    Fu WJ, Hong BF, Yang Y, Zhang X, Gao JP, Zhang L, Wang XX (2009) Vaporesection for managing benign prostatic hyperplasia using a 2-microm continuous-wave laser: a prospective trial with 1-year follow- up. BJU Int 103(3):352–356CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Thomas R. W. Herrmann
    • 1
    Email author
  • T. Bach
    • 2
  • F. Imkamp
    • 1
  • A. Georgiou
    • 3
  • M. Burchardt
    • 3
  • M. Oelke
    • 1
    • 4
  • A. J. Gross
    • 2
  1. 1.Department of Urology and Urological OncologyHannover Medical SchoolHannoverGermany
  2. 2.Department of UrologyAsklepios Hospital BarmbekHamburgGermany
  3. 3.Department of UrologyUniversity ClinicGreifswaldGermany
  4. 4.Department of Urology, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands

Personalised recommendations