Laser enucleation of the prostate (HOLEP and THUlEp): a comparative effectiveness analysis in treating recurrent prostatic hyperplasia


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Abstract

Introduction. The estimated recurrence rate of benign prostatic hyperplasia (BPH) after transurethral resection of the prostate is about 5 to 15%. Laser enucleation of the prostate results in a much lower recurrence rate (not exceeding 1-1.5%). At the same time, laser enucleation of the prostate is still not widely used for recurrent prostatic hyperplasia since it believed to be technically difficult in cases. Aim. To describe the distinctive features of thulium and holmium laser enucleations of the prostate in the management of recurrent BPH and show that the technical difficulties are not an obstacle to the wide application of this technique. Materials and methods. This was a retrospective study comprising 676 patients aged 54 to 87 years with clinically pronounced infravesical obstruction due to prostatic hyperplasia (IPSS>20, Qmax<10). All patients were divided into four groups. Groups 1 («=489) and 3 (n=153) underwent holmium (HoLEP) and thulium (ThuLEP) laser enucleations of the prostate, respectively. Groups 2 (n=23) and 4 (n=11) included patients with BPH recurrence after HoLEP (group 2) and ThuLEP (group 4). All patients underwent diagnostic evaluation at baseline and at 6 months after surgery. Results. The mean ThuLEP operating time was shorter than that of HoLEP (p=0.02). The mean duration of repeat and primary ThuLEP and HoLEP did not differ statistically significantly (p>0.05). There was no difference in the length of hospitalization and catheterization between the four groups (p>0.05). At six months after surgery, a statistically significant improvement in I-PSS, Qmax, QoL, and RUV was observed in all groups compared with preoperative values (p>0.05)). Conclusion. We found that the technical difficulties of the re-operation, such as the difficult separation of adenomatous tissue from the prostate capsule, the multinodular nature of the adenoma, increased tissue density are easy to overcome and do not confer a significant complexity. In turn, better completeness of resection, low complication and recurrence rates and the possibility of surgery, even in elderly patients with multiple comorbidities - these features allow us to conclude that laser enucleation of the prostate is not only an effective treatment for infravesical obstruction due to benign prostatic hyperplasia, but is also a method of choice in the treatment of patients with recurrent BPH.

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About the authors

D. V Enikeev

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University); Research Institute for Uronephrology and Human Reproductive Health

Email: enikeev_dv@mail.ru
Deputy Director for Science

P. V Glybochko

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University); Research Institute for Uronephrology and Human Reproductive Health

Email: rektorat@mma.ru
Academician of the RAS, Dr.Med.Sci., Prof., Rector; Director

Yu. G Alyaev

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University); Research Institute for Uronephrology and Human Reproductive Health

Email: ugalyaev@mail.ru
Corr.-Member of the RAS, Dr.Med.Sci., Prof., Head of Department of Urology; Director of the Urology Clinic

L. M Rapoport

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University); Research Institute for Uronephrology and Human Reproductive Health

Email: leonidrapoport@yandex.ru
Dr.Med.Sci., Professor at the Department of Urology; Deputy Director for Clinical Care

N. I Sorokin

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: nisorokin@mail.ru
Head of the Department of Oncologic Urology, Urology Clinic

M. E Enikeev

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: enikmic@mail.ru
Dr.Med.Sci., Head of the 2nd Department of the Urology Clinic, Professor at the Department of Urology

A. M Dymov

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: alimd@mail.ru
Ph.D., Physician at the Department of Oncologic Urology, Urology Clinic

R. B Sukhanov

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University); Research Institute for Uronephrology and Human Reproductive Health

Email: rb_suhanov@mail.ru
Ph.D., Teaching Assistant at the Department of Urology

O. Kh Khamraev

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University); Research Institute for Uronephrology and Human Reproductive Health

Email: doc.bek@mail.ru
Ph.D. Student at the Department of Urology

M. S Taratkin

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: marktaratkin@gmail.com
Resident at the Department of Urology

A. V Dymova

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: lisuney@mail.ru
Sixth Year Student, Medical Faculty

J. S Inoyatov

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: inoyat@yandex.ru
urologist, Urology Clinic

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