Bipolar and laser endoscopic enucleation for large benign prostatic hyperplasia

Background: endoscopic enucleation is a conventional minimally invasive method of surgical treatment for large prostates. Aim: The aim of the study was to analyze preoperative, intraoperative, immediate postoperative outcomes and 12-month functional results of endoscopic enucleation of the prostate. Materials and methods: a total of 120 endoscopic enucleations were performed in the Department of Urology, City Clinical Hospital named after D.D. Pletnev in 2016-2017. Bipolar electroenucleation was performed in 63 cases, while laser enucleation was done in 57 patients (28 holmium and 29 thulium). Three-lobe, two-lobe and en-block electroenucleation was performed in 23, 24 and 16 patients, respectively. The technical advantages of laser enucleation included lesser need for mechanical traction during enucleation of the adenoma from the prostatic capsule and the predominant use of two-lobe technique (33 cases). En-block laser enucleation was done in 7 patients, while three-lobe technique was used in 17 patients. Both groups were comparable in terms of I-PSS, QoL, prostate volume, maximum urination rate, and residual urine volume. Results: weight of the removed adenoma after electroenucleation was 105+24 g and 98+18 g after laser enucleation; the operation time was 118+10 and 132+25 min, duration of the catheterization 48+16 and 51+10 h, length of stay 3.6+1.2 and 3.8+1.3 days, respectively. Closed prostate perforation more often occurred after electrosurgical enucleation (6 vs. 1). There were no significant differences in the outcomes in both groups one year after the surgery. After removal of the urethral catheter, incontinence developed in 9% (6/63 and 5/57, respectively) of cases. During the period from 6 to 12 months, urinary incontinence persisted only in one patient, who subsequently was underwent to injection therapy with a partially positive effect. All 22 patients with urinary disturbances that occurred after enucleation had a short distance from the top of the verumontanum to the external sphincter (less than 1.5 cm; risk ratio (RR) = 3.5) and intravesical protrusion of more than 1 cm (RR=2.1). Conclusion: endoscopic bipolar and laser enucleation is an effective and safe treatment method for large BPH. It should be noted that postoperatively there was an increased frequency of irritative symptoms, which disappeared by 6 months.

holmium laser, thulium laser, enucleation