videour2014.

003000e

TRANSURETHRAL THULIUM LASER VAPO-RESECTION VERSUS TRANSVESICAL OPEN ENUCLEATION FOR

PROSTATE ADENOMA GREATER THAN 80 G: A STUDY OF 78 PATIENTS.
Carmignani L, Picozzi S, Bozzini G, Ratti D, Maruccia S, Macchi A, Osmolovskiy° B, Kamalov° A
Academic Dep. Of Urology, University of Milan, Policlinico San Donato °Urology Department, Lomonosov Moscow State University

Aim Materials and methods Conclusion

ThuLep and open prostatectomy are equally effective
procedures for removal of large prostatic adenomas. ThuLep
resulted in significantly less perioperative morbidity and may
Prostate adenomas greater than 80 ml have traditionally A cooperation between the University of Milan and Moscow was settled.
become the endourological alternative to open prostatectomy.
been treated with open prostatectomy or transurethral A total of 78 obstructed patients with a prostate larger than 80 ml on
resection by skilled resectionists. This procedure may involve transrectal ultrasound undergo ThuLEP or open prostatectomy. All
considerable blood loss, morbidity, prolonged hospital stay patients were assessed preoperatively and postoperatively. Patient
and recovery time. We compare transurethral Thulium laser baseline characteristics, perioperative data and postoperative outcome Thulep Open
enucleation (ThuLEP) of the prostate to open prostatectomy were compared. All complications were noted. Prostatectomy
for the surgical management of large prostate adenomas. 110 (65 - 140) 85 (70 - 125)
Operative time (min)
Results Resected weight (g) 41,7 82,7
Thulep Open
14,2 13,6
Prostatectomy
Preop hemoglobin (g/dl)
12,6 10,4
No. of pts 48 30 Postop hemoglobin (g/dl)
48 patients undergo to ThuLep and 30 to open prostatectomy. Mean
Age (years) 78 (54 - 85) 72 (57 - 82) patient age is 78 in the ThuLep group and 72 in the open Hemoglobin decrease 1,6 3,2
adenomectomy group. Mean preoperatory transrectal adenoma volume (g/dl)
5.9 (0,5 - 18,7) 3,49 (0,8 – 13,1)
PSA (ng/ml) is 126 ml and 115 ml respectively. Mean Hemoglobin loss was Transfusion rate (%) 0 6 (20%)
significantly less (p<0,05), and catheterization time (p<0,05) and Catheterization time 1 (1-3) 7 (6-12)
126,4 (80 - 115 (80 - 219) hospital stay (p<0,05) were significantly shorter in the Thulep group.
TRUS vol (ml) (day)
250) Adverse events (p<0,05) were more frequent in the open prostatectomy
group such as prolonged haematuria, surgical infection, fever and Hospital stay (day) 2 (1-7) 10 (7-21)
IPSS 18 17 analgesic drugs use. None of the Thulium group patients needed blood Preop IPSS 18 18,3
transfusions in contrast to 6 patients (20%) in the prostatectomy group. Postop IPSS 7th day 6,3 7,5
9,6 (3,9 – 15) 7,4 (4,3 – 12,2)
Qmax (ml/s) 4,0 3,5
Postop IPSS 30th day
6 8
Bladder stone (pts) Preop Fmax 6.3 7.4
20.39 Nr
8 7 Postop Fmax 7th day
Urinary catheter
20.83 24.7
Postop Fmax 30th day