Skip to main content

Advertisement

Log in

Feasibility and efficacy of Thulium:YAG laser enucleation (VapoEnucleation) of the prostate

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Thulium:YAG (Tm:YAG) vaporesection has been introduced and efficiency was shown on smaller prostates. Criticism mainly referred to prolonged operation time in larger prostates, which appears to be a potential limitation compared to HoLEP. Aim of the study was to evaluate feasibility and efficiency of Tm:YAG VapoEnucleation in larger prostates.

Methods

VapoEnucleation was performed using a 70 W continuous wave-laser. After enucleation tissue was morcellated within the bladder. Prospectively assessed outcomes were improvement in urodynamic parameter and the intra- and postoperative course. Complications were recorded.

Results

A total of 88 consecutive patients with prostatic enlargement underwent VapoEnucleation. Prostatic volume was 61.3 ± 24.0 cc (30–160). OR-time was 72 min ± 26.6 (35–144) and laser-time 32.4 ± 10.1 min (16.3–59.3). Applied laser energy was 123.7 ± 40.6 kJ (67.8–240.9). An average of 31.7 ± 18.3 g of tissue was retrieved. Pathology revealed four patients with incidental carcinoma. Foley catheter-time was 2 days and the suprapubic tube, if placed, was removed on the third postoperative day on average. Twelve complications were recorded, including bleeding (3), urinary tract infection (6), second-look procedure, due to insufficient deobstruction (2). Re-catherization after successful initial voiding trial was necessary in one patient. Mean peak flow rate improved from 3.5 ± 4.7 to 19.8 ± 11.6 ml/s and post-voiding residual urine decreased from 121.4 ± 339.9 to 22.4 ± 32.7 ml.

Conclusion

The functional outcomes demonstrate efficiency of Tm:YAG VapoEnucleation for patients with larger prostates. From our experience, learning curve in VapoEnucleation is short and complications are minimal. Theoretically, no limitation in prostate size occurs. Long-term follow-up is needed to prove durability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Bach T, Herrmann TR, Ganzer R, Burchardt M, Gross AJ (2007) RevoLix vaporesection of the prostate: initial results of 54 patients with a one year follow-up. World J Urol 25:257–262. doi:10.1007/s00345-007-0171-x

    Article  PubMed  Google Scholar 

  2. Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN (2008) Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol 53:382–389. doi:10.1016/j.eururo.2007.05.019

    Article  PubMed  Google Scholar 

  3. Elzayat EA, Elhilali MM (2005) Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy. Eur Urol 49:87–91. doi:10.1016/j.eururo.2005.08.015

    Article  PubMed  Google Scholar 

  4. Gilling P (2008) Holmium laser enucleation of the prostate (HoLEP). BJU Int 101:131–142

    PubMed  Google Scholar 

  5. Serretta V, Morgia G, Fondacaro L, Curto G, Lo Bianco A, Pirritano D et al (2002) Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology 60:623–627. doi:10.1016/S0090-4295(02)01860-5

    Article  PubMed  Google Scholar 

  6. Mearini E, Marzi M, Mearini L, Zucchi A, Porena M (1998) Open prostatectomy in benign prostatic hyperplasia: 10-year experience in Italy. Eur Urol 34:480–485. doi:10.1159/000019787

    Article  PubMed  CAS  Google Scholar 

  7. Gilling PJ, Kennett K, Das AK, Thompson D, Fraundorfer MR (1998) Holmium laser enucleation of prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol 12:457–459

    Article  PubMed  CAS  Google Scholar 

  8. Gilling PJ, Aho TF, Framptom CM, King CJ, Fraundorfer MR (2008) Holmium laser enucleation of the prostate: results at 6 years. Eur Urol 53:744–749. doi:10.1016/j.eururo.2007.04.052

    Article  PubMed  Google Scholar 

  9. Elzayaz EA, Elhilali MM (2006) Laser treatment of symptomatic benign prostatic hyperplasia. World J Urol 24:410–417. doi:10.1007/s00345-006-0063-5

    Article  Google Scholar 

  10. Seki N, Mocida O, Kinukawa N, Sagiyama K, Nato S (2003) Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the curse of 70 consecutive cases. J Urol 170:1847–1850. doi:10.1097/01.ju.0000092035.16351.9d

    Article  PubMed  Google Scholar 

  11. Wendt-Nordahl G, Huckele S, Honeck P, Alken P, Knoll T, Michel MS, Häcker A (2008) Systemic evaluation of a recently introduced 2-micron contiuous-wave laser for vaporesection of the prostate. J Endourol 22:1041–1045. doi:10.1089/end.2007.0421

    Article  PubMed  Google Scholar 

  12. Bach T, Igelmann HerrmannTRW, Ganzer R, Gross AJ (2008) Thulium:YAG vaporesection of the prostate: expert versus novice-functional outcome. Eur Urol Suppl 7:203. doi:10.1016/S1569-9056(08)60528-X Abstract 532

    Article  Google Scholar 

  13. Vavassori I, Hurle R, Vismara A, Manzetti A, Valenti S (2004) Holmium laser enucleation of the prostate combined with mechanical morcellation: two years of experience with 196 patients. J Endourol 18:109–112. doi:10.1089/089277904322836767

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

There is no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T. Bach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bach, T., Wendt-Nordahl, G., Michel, M.S. et al. Feasibility and efficacy of Thulium:YAG laser enucleation (VapoEnucleation) of the prostate. World J Urol 27, 541–545 (2009). https://doi.org/10.1007/s00345-008-0370-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-008-0370-0

Keywords

Navigation