Ümit YILDIRIM, Mehmet EZER, Mehmet USLU, Bumin ÖRS, Fatih GOKALP

Prostatın Yüksek Güçlü (200w) Thulium Lazer Vapoenükleasyonu Fonksiyonel Parametreleri Nasıl Etkiliyor? Kısa Dönem Sonuçlarımız

Amaç: Benign prostat hiperplazisi tedavisinde kullanılan yüksek güçlü (200 W) Thulium:YAG lazer vapoenükleasyonun etkinlik ve güvenilirliğini, bu prosedürün alt üriner sistem semptomları, erektil ve ejakülatuar fonksiyonlar üzerindeki etkisini değerlendirmek amacıyla, sunulan bu prospektif çalışmayı yürüttük. Gereç ve Yöntemler: Aralık 2021 ile Haziran 2022 arasında, benign prostat hiperplazisinin belirti ve semptomlarını tedavi etmek için kliniğimizde Thulium vapoenükleasyon (ThuVEP) uygulanan hastaların verileri prospektif olarak toplandı. Hariç tutma kriterleri uygulandıktan sonra 50 vakalık bir örneklem büyüklüğü elde edildi. Ameliyatı takip eden 1. ve 6. aylarda tüm hastalar alt üriner sistem semptomları, erektil fonksiyon ve ejakülasyon semptomları açısından ameliyat öncesi durumları ile karşılaştırıldı. Oluşan komplikasyonları sınıflandırmak için Modifiye Clavien-Dindo Sınıflandırması da kullanıldı. Bulgular: Hastaların IPSS skorlarında 6 aylık takip sonunda belirgin ve anlamlı bir iyileşme görüldü. Ameliyat öncesi durumla karşılaştırıldığında, IIEF-5 skoru ile ölçülen erektil fonksiyonlar ameliyatla önemli ölçüde değişmedi. Takip süresinin sonunda, MSHQ-EjD skoru ile ölçülen ejakülasyon fonksiyonlarında önemli bir bozulma oldu. İşlem sırasında ve sonrasında hastaların 2'sinde (%4) Clavien 3a seviyesinde komplikasyon görüldü, ancak bu seviyenin üzerinde komplikasyon görülmedi. Sonuç: Semptomatik benign prostat hiperplazisinin cerrahi tedavisinde kullanılan ThuVEP yöntemi, yüksek güçlü (200 W) vapoenükleasyona rağmen fonksiyonel sonuçlar açısından güvenli ve etkilidir. Bu alanda daha uzun takipli randomize kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

thulium, lazer, vapoenükleasyon, erektil, fonksiyonel

How Is High Power (200w) Thulium Laser Vapoenucleation of the Prostate Impacting Functional Parameters? Short-Term Follow-Up Results

Objective: To assess the efficacy and safety of thulium laser vapoenucleation of the prostate and its impact on patient’s lower urinary tract symptoms, erectile, and ejaculatory functions, we conducted the current prospective trial employing a high-power (200 W) Thulium: YAG laser system. Material and Methods: Between December 2021 and June 2022, we prospectively collected data on patients who underwent Thulium vapoenucleation of the prostate (ThuVEP) in our clinic to treat the signs and symptoms of benign prostatic hyperplasia. A sample size of 50 cases was obtained after applying exclusion criteria. In the first and sixth months following surgery, all patients were compared to their preoperative status in terms of lower urinary tract symptoms, erectile function, and ejaculatory symptoms. The Modified Clavien-Dindo Classification was also used to classify the complications that occurred. Results: The patients' IPSS scores showed a notable and significant improvement at the end of the 6-month follow-up. When compared to the preoperative state, erectile functions as measured by the IIEF-5 score did not significantly change with the surgery. At the end of the follow-up period, there was a substantial deterioration of ejaculatory functions as measured by the MSHQ-EjD score. During and after the procedure, complications at the Clavien 3a level were seen in 2 (4%) of the patients, but no complications above this level were seen. Conclusion: The ThuVEP method, used in the surgical management of symptomatic benign prostatic hyperplasia, is safe and effective in terms of functional outcomes despite high-power (200 W) vapoenucleation. In this field, further randomized controlled studies with extended follow-up are required.

Keywords:

thulium, laser, vapoenucleation, erectile, functional,

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1. Lokeshwar SD, Harper BT, Webb E, et al. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol. 2019;8(5):529. https://doi.org/10.21037/TAU.2019.10.01
2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-2196. https://doi.org/10.1016/S0140-6736(12)61729-2
3. J.N. Cornu (Chair), M. Gacci, H. Hashim, et al. EAU Guidelines on Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), Incl. Benign Prostatic Obstruction (BPO). In: ISBN 978-94-92671-19-6 Milan; 2023
4. Herrmann TRW, Bach T, Imkamp F, et al. 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. World J Urol. 2010;28(1):45-51 https://doi.org/10.1007/S00345-009-0503-0/TABLES/1
5. Bach T, Wendt-Nordahl G, Michel MS, et al. Feasibility and efficacy of Thulium:YAG laser enucleation (VapoEnucleation) of the prostate. World Journal of Urology. 2009;27(4):541-545. https://doi.org/10.1007/S00345-008-0370-0
6. Herrmann TRW, Wolters M. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): Evolution and variations of the technique. The inventors’ perspective. Andrologia. 2020;52(8):e13587 https://doi.org/10.1111/AND.13587
7. Lee JS, Chung BH. Transrectal ultrasound versus magnetic resonance imaging in the estimation of prostate volume as compared with radical prostatectomy specimens. Urol Int. 2007;78(4):323-327. https://doi.org/10.1159/000100836
8. GÜVEL S, TURUNÇ T, PEŞKİRCİOĞLU L, et al. Uluslararası cinsel işlev indeksinin 5 soruluk versiyonunun (IIEF-5) Türkçe geçerlilik çalışmasının değerlendirilmesi. Türk Üroloji Dergisi/Turkish Journal of Urology. 2007;33(1):45-49
9. Bozlu M, Doruk E, Akbay E, et al. Effect of administration mode (patient vs physician) and patient’s educational level on the Turkish version of the International Prostate Symptom Score. International Journal of Urology. 2002;9(8):417-421. https://doi.org/10.1046/J.1442-2042.2002.00491.X
10. Atalay HA, Çetinkaya G, Agalarov S, et al. Readability and understandability of andrology questionnaires. Turk J Urol. 2019;45(3):171-176. https://doi.org/10.5152/TUD.2018.75272
11. Saitta G, Becerra JEA, del Álamo JF, et al. ‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia. World J Urol. 2019;37(11):2451-2458. https://doi.org/10.1007/S00345-019-02671-4/TABLES/2
12. Graefen M. The modified Clavien system: a plea for a standardized reporting system for surgical complications. Eur Urol. 2010;57(3):387-389. https://doi.org/10.1016/J.EURURO.2009.12.020
13. Michalak J, Tzou D, Funk J. HoLEP: the gold standard for the surgical management of BPH in the 21st Century. Am J Clin Exp Urol. 2015;3(1):36.
14. Yan J, Gao L, Xu G, et al. The effectiveness and safety of three surgical procedures for the treatment for benign prostatic hyperplasia: A network meta-analysis. Heliyon. 2022;8(10). https://doi.org/10.1016/J.HELIYON.2022.E10884
15. Fried NM, Murray KE. High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol. 2005;19(1):25-31. https://doi.org/10.1089/END.2005.19.25 16. Xia S, Zhang Y, Lu J, et al. [Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia]. Zhonghua Yi Xue Za Zhi. 2005;85(45):3225-8.
17. Bach T, Muschter R, Sroka R, et al. Laser Treatment of Benign Prostatic Obstruction: Basics and Physical Differences. Eur Urol. 2012;61(2):317-325. https://doi.org/10.1016/J.EURURO.2011.10.009
18. Teichmann HO, Herrmann TR, Bach T. Technical aspects of lasers in urology. World J Urol. 2007;25(3):221-225. https://doi.org/10.1007/S00345-007-0184-5/FIGURES/1
19. Al Demour SH, Abuhamad M, Santarisi AN, et al. The Effect of Transurethral Resection of the Prostate on Erectile and Ejaculatory Functions in Patients with Benign Prostatic Hyperplasia. Urol Int. 2022;106(10):1. https://doi.org/10.1159/000524957
20. Bruce A, Krishan A, Sadiq S, et al. Safety and Efficacy of Bipolar Transurethral Resection of the Prostate vs Monopolar Transurethral Resection of Prostate in the Treatment of Moderate-Large Volume Prostatic Hyperplasia: A Systematic Review and Meta-Analysis. J Endourol. 2021;35(5):663-673. https://doi.org/10.1089/END.2020.0840
21. Lan Y, Wu W, Liu L, et al. Thulium (Tm:YAG) laser vaporesection of prostate and bipolar transurethral resection of prostate in patients with benign prostate hyperplasia: a systematic review and meta-analysis. Lasers Med Sci. 2018;33(7):1411-1421. https://doi.org/10.1007/S10103-018-2539-0/TABLES/3
22. Carmignani L, Bozzini G, Macchi A, et al. Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia. Asian J Androl. 2015;17(5):802. https://doi.org/10.4103/1008-682X.139255
23. Iacono F, Prezioso D, Di Lauro G, et al. Efficacy and safety profile of a novel technique, ThuLEP (Thulium laser enucleation of the prostate) for the treatment of benign prostate hypertrophy. Our experience on 148 patients. BMC Surg. 2012;12(Suppl 1):S21. https://doi.org/10.1186/1471-2482-12-S1-S21
24. Tiburtius C, Knipper S, Gross AJ, et al. Impact of thulium VapoEnucleation of the prostate on erectile function: a prospective analysis of 72 patients at 12-month follow-up. Urology. 2014;83(1):175-180. https://doi.org/10.1016/J.UROLOGY.2013.08.029
25. Saredi G, Pacchetti A, Pirola GM, et al. Impact of Thulium Laser Enucleation of the Prostate on Erectile, Ejaculatory and Urinary Functions. Urol Int. 2016;97(4):397-401. https://doi.org/10.1159/000446829.
26. Chang CH, Lin TP, Huang JY. Safety and effectiveness of high-power thulium laser enucleation of the prostate in patients with glands larger than 80 mL. BMC Urol. 2019;19(1). https://doi.org/10.1186/S12894-019-0437-9
27. Gross AJ, Netsch C, Knipper S, et al. Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: results at a single institution. Eur Urol. 2013;63(5):859-867. https://doi.org/10.1016/J.EURURO.2012.11.048
28. Raber M, Buchholz NNP, Vercesi A, et al. Thulium laser enucleation of the prostate (ThuLEP): Results, complications, and risk factors in 139 consecutive cases. 2019;16(4):411-416. https://doi.org/10.1016/J.AJU.2018.05.004.
29. Wani MM, Sriprasad S, Bhat T, et al. Is Thulium laser enucleation of prostate an alternative to Holmium and TURP surgeries - A systematic review? Turk J Urol. 2020;46(6):419-426. https://doi.org/10.5152/TUD.2020.20202
30. Tiburtius C, Gross AJ, Netsch C. A prospective, randomized comparison of a 1940 nm and a 2013 nm thulium: yttrium-aluminum-garnet laser device for Thulium VapoEnucleation of the prostate (ThuVEP): First results. Indian Journal of Urology. 2015;31(1):47. https://doi.org/10.4103/0970-1591.148308.
31. Pearce SM, Pariser JJ, Malik RD, et al. Outcomes following Thulium vapoenucleation of large prostates. International braz j urol. 2016;42(4):757-765. https://doi.org/10.1590/S1677-5538.IBJU.2015.0424.
32. Pariser JJ, Famakinwa OJ, Pearce SM, et al. High-power thulium laser vaporization of the prostate: short-term outcomes of safety and effectiveness. J Endourol. 2014;28(11):1357-1362; https://doi.org/10.1089/END.2014.0336.