Ejaculation Sparing Thulium Laser Enucleation of the Prostate: An Observational Prospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Statistical Analysis
2.2. Surgical Technique
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Cannarella, R.; Condorelli, R.A.; Barbagallo, F.; La Vignera, S.; Calogero, A.E. Endocrinology of the Aging Prostate: Current Concepts. Front. Endocrinol. 2021, 12, 554078. [Google Scholar] [CrossRef] [PubMed]
- Gandaglia, G.; Briganti, A.; Gontero, P.; Mondaini, N.; Novara, G.; Salonia, A.; Sciarra, A.; Montorsi, F. The Role of Chronic Prostatic Inflammation in the Pathogenesis and Progression of Benign Prostatic Hyperplasia (BPH): Chronic Prostatic Inflammation in BPH Pathogenesis and Progression. Br. J. Urol. 2013, 112, 432–441. [Google Scholar] [CrossRef] [PubMed]
- Abdelmoteleb, H.; Jefferies, E.R.; Drake, M.J. Assessment and Management of Male Lower Urinary Tract Symptoms (LUTS). Int. J. Surg. 2016, 25, 164–171. [Google Scholar] [CrossRef] [PubMed]
- Cornu, J.-N.; Ahyai, S.; Bachmann, A.; de la Rosette, J.; Gilling, P.; Gratzke, C.; McVary, K.; Novara, G.; Woo, H.; Madersbacher, S. A Systematic Review and Meta-Analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur. Urol. 2015, 67, 1066–1096. [Google Scholar] [CrossRef] [PubMed]
- Sagen, E.; Namnuan, R.-O.; Hedelin, H.; Nelzén, O.; Peeker, R. The Morbidity Associated with a TURP Procedure in Routine Clinical Practice, as Graded by the Modified Clavien-Dindo System. Scand. J. Urol. 2019, 53, 240–245. [Google Scholar] [CrossRef]
- Kuntz, R.M. Current Role of Lasers in the Treatment of Benign Prostatic Hyperplasia (BPH). Eur. Urol. 2006, 49, 961–969. [Google Scholar] [CrossRef]
- Gratzke, C.; Bachmann, A.; Descazeaud, A.; Drake, M.J.; Madersbacher, S.; Mamoulakis, C.; Oelke, M.; Tikkinen, K.A.O.; Gravas, S. EAU Guidelines on the Assessment of Non-Neurogenic Male Lower Urinary Tract Symptoms Including Benign Prostatic Obstruction. Eur. Urol. 2015, 67, 1099–1109. [Google Scholar] [CrossRef] [PubMed]
- Bach, T.; Wendt-Nordahl, G.; Michel, M.S.; Herrmann, T.R.W.; Gross, A.J. Feasibility and Efficacy of Thulium:YAG Laser Enucleation (VapoEnucleation) of the Prostate. World J. Urol. 2009, 27, 541–545. [Google Scholar] [CrossRef]
- Cheng, B.K.; Li, T.C.; Yu, C.H. Sexual Outcomes of Endoscopic Enucleation of Prostate. Andrologia 2020, 52, e13724. [Google Scholar] [CrossRef]
- Franco, J.V.A.; Jung, J.H.; Imamura, M.; Borofsky, M.; Omar, M.I.; Liquitay, C.M.E.; Young, S.; Golzarian, J.; Veroniki, A.A.; Garegnani, L.; et al. Minimally Invasive Treatments for Benign Prostatic Hyperplasia: A Cochrane Network Meta-analysis. Br. J. Urol. 2022, 130, 142–156. [Google Scholar] [CrossRef]
- Gratzke, C.; Barber, N.; Speakman, M.J.; Berges, R.; Wetterauer, U.; Greene, D.; Sievert, K.-D.; Chapple, C.R.; Patterson, J.M.; Fahrenkrug, L.; et al. Prostatic Urethral Lift vs Transurethral Resection of the Prostate: 2-Year Results of the BPH6 Prospective, Multicentre, Randomized Study. Br. J. Urol. 2017, 119, 767–775. [Google Scholar] [CrossRef]
- Sturch, P.; Woo, H.H.; McNicholas, T.; Muir, G. Ejaculatory Dysfunction after Treatment for Lower Urinary Tract Symptoms: Retrograde Ejaculation or Retrograde Thinking? Br. J. Urol. 2015, 115, 186–187. [Google Scholar] [CrossRef] [PubMed]
- Talab, S.S.; Santiago-Lastra, Y.A.; Bachmann, A.; Choi, B.B.; Muir, G.H.; Woo, H.H.; Tabatabaei, S. V403 The impact of ejaculation-preserving photo-selective vaporization of the prostate (ep-pvp) on lower urinary tract symptoms and ejaculatory function: Results of a multicenter study. J. Urol. 2013, 189, e164. [Google Scholar] [CrossRef]
- Alloussi, S.H.; Lang, C.; Eichel, R.; Alloussi, S. Ejaculation-Preserving Transurethral Resection of Prostate and Bladder Neck: Short- and Long-Term Results of a New Innovative Resection Technique. J. Endourol. 2014, 28, 84–89. [Google Scholar] [CrossRef]
- Bozzini, G.; Berti, L.; Maltagliati, M.; Besana, U.; Calori, A.; Müller, A.; Sighinolfi, M.C.; Micali, S.; Pastore, A.L.; Ledezma, R.; et al. Ejaculation-Sparing Thulium Laser Enucleation of the Prostate (ES-ThuLEP): Outcomes on a Large Cohort. World J. Urol. 2021, 39, 2029–2035. [Google Scholar] [CrossRef] [PubMed]
- Vittori, M.; Bertolo, R.; Maiorino, F.; Cipriani, C.; Carilli, M.; Signoretti, M.; Iacovelli, V.; Antonucci, M.; Bove, P. Thulium Laser Enucleation of Prostate: Ejaculation Sparing Techniques. Urol. Video J. 2022, 13, 100129. [Google Scholar] [CrossRef]
- Badía, X.; García-Losa, M.; Dal-Ré, R. Ten-Language Translation and Harmonization of the International Prostate Symptom Score: Developing a Methodology for Multinational Clinical Trials. Eur. Urol. 1997, 31, 129–140. [Google Scholar] [CrossRef] [PubMed]
- Rosen, R.; Cappelleri, J.; Smith, M.; Lipsky, J.; Peña, B. Development and Evaluation of an Abridged, 5-Item Version of the International Index of Erectile Function (IIEF-5) as a Diagnostic Tool for Erectile Dysfunction. Int. J. Impot. Res. 1999, 11, 319–326. [Google Scholar] [CrossRef] [Green Version]
- McKown, S.; Abraham, L.; Coyne, K.; Gawlicki, M.; Piault, E.; Vats, V. Linguistic Validation of the N-QOL (ICIQ), OAB-q (ICIQ), PPBC, OAB-S and ICIQ-MLUTSsex Questionnaires in 16 Languages: Linguistic Validation of 5 OAB Questionnaires. Int. J. Clin. Pr. 2010, 64, 1643–1652. [Google Scholar] [CrossRef]
- Lerner, L.B.; McVary, K.T.; Barry, M.J.; Bixler, B.R.; Dahm, P.; Das, A.K.; Gandhi, M.C.; Kaplan, S.A.; Kohler, T.S.; Martin, L.; et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART II—Surgical Evaluation and Treatment. J. Urol. 2021, 206, 818–826. [Google Scholar] [CrossRef]
- Nair, S.M.; Pimentel, M.A.; Gilling, P.J. A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia). Curr. Urol. Rep. 2016, 17, 45. [Google Scholar] [CrossRef] [PubMed]
- Bozzini, G.; Berti, L.; Aydoğan, T.B.; Maltagliati, M.; Roche, J.B.; Bove, P.; Besana, U.; Calori, A.; Pastore, A.L.; Müller, A.; et al. A Prospective Multicenter Randomized Comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enucleation of the Prostate (ThuLEP). World J. Urol. 2021, 39, 2375–2382. [Google Scholar] [CrossRef] [PubMed]
- Zhang, F.; Shao, Q.; Herrmann, T.R.W.; Tian, Y.; Zhang, Y. Thulium Laser Versus Holmium Laser Transurethral Enucleation of the Prostate: 18-Month Follow-up Data of a Single Center. Urology 2012, 79, 869–874. [Google Scholar] [CrossRef]
- Pirola, G.M.; Saredi, G.; Duarte, R.C.; Bernard, L.; Pacchetti, A.; Berti, L.; Martorana, E.; Carcano, G.; Badet, L.; Fassi-Fehri, H. Holmium Laser versus Thulium Laser Enucleation of the Prostate: A Matched-Pair Analysis from Two Centers. Ther. Adv. Urol. 2018, 10, 223–233. [Google Scholar] [CrossRef] [Green Version]
- Zhang, J.; Ou, Z.; Zhang, X.; He, W.; Wang, R.; Mo, M.; Chen, L.; Xu, R.; Jiang, S.; Peng, X.; et al. Holmium Laser Enucleation of the Prostate versus Thulium Laser Enucleation of the Prostate for the Treatment of Large-Volume Prostates > 80 Ml: 18-Month Follow-up Results. World J. Urol. 2020, 38, 1555–1562. [Google Scholar] [CrossRef]
- DeLay, K.J.; Nutt, M.; McVary, K.T. Ejaculatory Dysfunction in the Treatment of Lower Urinary Tract Symptoms. Transl. Androl. Urol. 2016, 5, 450–459. [Google Scholar] [CrossRef] [Green Version]
- Leong, J.Y.; Patel, A.S.; Ramasamy, R. Minimizing Sexual Dysfunction in BPH Surgery. Curr. Sex. Health Rep. 2019, 11, 190–200. [Google Scholar] [CrossRef] [PubMed]
- Madersbacher, S.; Roehrborn, C.G.; Oelke, M. The Role of Novel Minimally Invasive Treatments for Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: Novel LUTS/BPH Minimally Invasive Treatments. Br. J. Urol. 2020, 126, 317–326. [Google Scholar] [CrossRef]
- Ronzoni, G.; De Vecchis, M. Preservation of Anterograde Ejaculation after Transurethral Resection of Both the Prostate and Bladder Neck. Br. J. Urol. 1998, 81, 830–833. [Google Scholar] [CrossRef] [PubMed]
- Kim, M.; Song, S.H.; Ku, J.H.; Kim, H.-J.; Paick, J.-S. Pilot Study of the Clinical Efficacy of Ejaculatory Hood Sparing Technique for Ejaculation Preservation in Holmium Laser Enucleation of the Prostate. Int. J. Impot. Res. 2015, 27, 20–24. [Google Scholar] [CrossRef]
- Brant, A.; Cho, A.; Calderon, L.P.; Te, A.; Kashanian, J.; Chughtai, B. Ejaculatory Hood-Sparing Vaporization of the Prostate and Its Impact on Erectile, Ejaculatory, and Sexual Function. Urology 2020, 144, 177–181. [Google Scholar] [CrossRef] [PubMed]
Age, years (mean ± SD) | 60 ± 11.5 |
PSA, ng/mL (mean ± SD) | 3.9 ± 2.3 |
Prostate volume, cc (mean ± SD) | 88.8 ± 32.2 |
Previous alpha-blocker therapy, n (%) | 64.2% |
Previous alpha blocker + 5 alpha-reductase inhibitor, n (%) | 24.5% |
Bladder catheter, n (%) | 5.6% |
Qmax, mL/s (mean ± SD) | 7.7 ± 2.5 |
Qave, mL/s (mean ± SD) | 5.2 ± 2 |
Voided volume, mL (mean ± SD) | 294.8 ± 87.5 |
PVR, mL (mean ± SD) | 82.1 ± 37.1 |
IPSS score (mean ± SD) | 25.7 ± 4.2 |
IIEF-5 score (mean ± SD) | 21.3 ± 2.9 |
Intra-Operative Parameters | |
Operative time, minutes (mean ± SD) | 147.7 ± 67.8 |
Hb drop, g/dL | 0.9 ± 0.7 |
Enucleated tissue weight, g (mean ± SD) | 31.2 ± 14.2 |
Use of thulium laser, minutes (mean ± SD) | 72.2 ± 11.3 |
Peri-Operative Parameters | |
Hospitalitazion, days (mean ± SD) | 3.2 ± 1.1 |
Stop bladder irrigation, days (mean ± SD) | 1.9 ± 0.9 |
Catheter removal, days (mean ± SD) | 2.8 ± 0.6 |
Acute urinary retention, n (%) | 2 (3.7%) |
Bladder neck sclerosis, n (%) | 1 (1.8%) |
Haematospermia at 3 months, n (%) | 5 (9.4%) |
Haematospermia at 6 months, n (%) | 3 (5.6%) |
Haematospermia at 9 months, n (%) | 0 (0%) |
Haematospermia at 12 months, n (%) | 0 (0%) |
Prostate adenocarcinoma, n (%) | 1 (1.8%) |
Baseline | 3 Months | 6 Months | 12 Months | p-Value | |
---|---|---|---|---|---|
Qmax, mL/s (mean ± SD) | 7.7 ± 2.5 | 20.8 ± 4.1 | 21.7 ± 4 | 20 ± 3.7 | <0.001 |
Qave, mL/s (mean ± SD) | 5.2 ± 2 | 12.6 ± 3.2 | 14.3 ± 3.7 | 13.8 ± 3.8 | <0.001 |
PSA level, ng/mL (mean ± SD) | 3.9 ± 2.3 | 2.2 ± 1.3 | 2.3 ± 1.3 | 1.8 ± 1.4 | <0.001 |
PVR, mL (mean ± SD) | 82.1 ± 37.1 | 18.8 ± 12.3 | 18.6 ± 12.4 | 23.4 ± 14.9 | <0.001 |
Voided volume, mL (mean ± SD) | 294.8 ± 87.5 | 294.5 ± 80.7 | 301.9 ± 90.2 | 302.9 ± 97.7 | 0.85 |
IPSS score | 25.7 ± 4.2 | 3.4 ± 2 | 5.6 ± 3.2 | 5.1 ± 3.4 | <0.001 |
IIEF-5 score | 21.3 ± 2.9 | 22.9 ± 3.8 | 20.4 ± 2.4 | 21.2 ± 2.6 | 0.052 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Trama, F.; Lauro, G.D.; Illiano, E.; Iacono, F.; Romis, L.; Mordente, S.; Nugnes, M.R.; Lai, S.; Crocetto, F.; Barone, B.; et al. Ejaculation Sparing Thulium Laser Enucleation of the Prostate: An Observational Prospective Study. J. Clin. Med. 2022, 11, 6365. https://doi.org/10.3390/jcm11216365
Trama F, Lauro GD, Illiano E, Iacono F, Romis L, Mordente S, Nugnes MR, Lai S, Crocetto F, Barone B, et al. Ejaculation Sparing Thulium Laser Enucleation of the Prostate: An Observational Prospective Study. Journal of Clinical Medicine. 2022; 11(21):6365. https://doi.org/10.3390/jcm11216365
Chicago/Turabian StyleTrama, Francesco, Giovanni Di Lauro, Ester Illiano, Fabrizio Iacono, Leo Romis, Salvatore Mordente, Maria Rosaria Nugnes, Stefano Lai, Felice Crocetto, Biagio Barone, and et al. 2022. "Ejaculation Sparing Thulium Laser Enucleation of the Prostate: An Observational Prospective Study" Journal of Clinical Medicine 11, no. 21: 6365. https://doi.org/10.3390/jcm11216365