Efficacy and learning curve of Thulium laser enucleation of the prostate by laser controller anchored at six o'clock position of bladder neck in the treatment of BPH with large gland
Objective To analyze the efficacy,safety and learning curve of Thulium laser enucleation of the prostate by laser controller(LC-THuLEP)anchored at six o'clock position of the bladder neck in the treatment of benign prostatic hyperplasia(BPH)with large gland.Methods The clinical data of the 1st to 45th BPH cases with large gland(prostate volume＞80 ml)treated by a doctor with LC-THuLEP anchored at six o'clock position of bladder neck in Shanghai East Hospital from January to October 2022 were retrospectively analyzed.The patients were divided into groups A,B and C according to the order of operation time,with 15 cases in each group.There were no significant differences among the three groups(P＞0.05)in age[(71.8±9.4)years old vs.(73.5±8.2)years old vs.(71.4±5.5)years old],prostate volume[88.3(84.8,100.6)ml vs.91.5(86.1,118.4)ml vs.94.5(84.7,101.8)ml],prostate specific antigen(PSA)[4.8(2.9,8.5)ng/ml vs.7.2(3.2,11.2)ng/ml vs.7.8(4.5,12.7)ng/ml],postvoid residual volume[44.0(34.0,67.0)ml vs.60.0(40.0,76.0)ml vs.39.0(0,59.0)ml],maximum urine flow rate(Qmax)[8.4(7.6,11.1)ml/s vs.8.6(6.5,10.6)ml/s vs.10.4(7.8,13.2)ml/s],international prostate symptom score(IPSS)[20(18,21)vs.20(20,22)vs.20(20,25)]and quality of life(QOL)[4(4,5)vs.4(4,4)vs.4(3,5)].The doctor had more than 100 cases of TURP surgery experience.LC-THuLEP anchored at six o'clock position of bladder neck was described as follows.The bladder neck at six o'clock position is reserved 0.5-1.0 cm as an"anchor"to fix the prostatic bladder neck when the gland was pushed directly by the laser controller,preventing the detached prostate gland from turning.Finally the bladder neck was cut off at six o'clock position,and the prostate was en-bloc removed.The effect of surgery and postoperative complications were compared.The enucleation efficiency was equal to the weight of prostate tissue removed divided by the time of enucleation.Results The differences among the three groups in operation time[100.0(90.0,110.0)min vs.80.0(70.0,90.0)min vs.75.0(70.0,90.0)min],enucleation time[89.0(72.0,97.0)min vs.67.0(64.0,77.0)min vs.64.0(60.0,77.0)min]and the efficiency of enucleation[0.65(0.62,0.68)g/min vs.0.84(0.83,0.94)g/min vs.0.93(0.82,1.00)g/min]were statistically significant(P＜0.05).The operation time and enucleation time in groups B and C were significantly lower than those in group A,and the enucleation efficiency was significantly higher than that in group A(P＜0.05),while there was no significant difference between group B and C.However,the difference of three groups in hemoglobin decrease[8.0(5.0,11.0)g/L vs.7.0(2.0,10.0)g/L vs.11.0(4.0,16.0)g/L]and catheter indwelling duration[4.0(2.0,6.0)d vs.6.0(3.0,7.0)d vs.4.0(3.0,6.0)d]were not statistically different(P＞0.05).All patients were followed up for 6 months after surgery.In three groups,postoperative Qmax were 23.2(21.0,25.1)ml/s,22.7(21.1,26.1)ml/s and 22.9(21.5,25.7)ml/s,IPSS were 6(5,8),7(6,8)and 7(7,8),QOL were 2(1,2),2(1,2)and 2(1,2),postvoid residual volume were 20.0(10.0,25.0)ml,22.0(15.0,25.0)ml and 5.0(0,25.0)ml,respectively,which were all significantly different from that of pre-operation(P＜0.05).However,there were no statistically significant differences in the postoperative indicators among the three groups(P＞0.05).No statistical difference was found in postoperative complications among the three groups[26.7％(4/15)vs.20.0％(3/15)vs.20.0％(3/15),P＞0.05].Conclusions LC-THuLEP anchored at six o'clock position of bladder neck was an effective operation in the treatment of BPH with large gland,and the learning curve could be reached after 15 cases.
Prostatic hyperplasiaEnucleation of prostateThulium laserLearning curve
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