Minimally invasive enucleation of the prostate (MiLEP) with thulium fiber laser: preliminary results
Introduction. Endoscopic enucleation of the prostate is the standard surgical treatment for patients with BPH >80 cc. Despite its efficiency, the incidence of stress urinary incontinence (<6 months) and urethral stricture remains significant at 16.6–29.4% and 1.7–6.5%, respectively. The use of smaller instruments can potentially reduce the rates of these complications. Aim. This study aims to evaluate the efficiency and safety of minimally invasive laser enucleation of the prostate (MiLEP) using a thulium fiber laser (TFL). Materials and methods. A prospective study was initiated in March 2024. The inclusion criteria were severe lower urinary tract symptoms (IPSS >20) and/or Qmax <15 ml/s or the necessity for bladder drainage. MiLEP was performed using 22 Ch resectoscope and TFL FIBERLASE U1 and FIBERLASE U-MAX (NTO IRE-Polus, Russia) with the following settings: 1.5 J and 50–55 Hz and 1.7–2 J and 40–45 Hz (DissectPulse). MiLEP technique was en bloc no-touch enucleation with early apical release. Peri- and early postoperative outcomes and complication rates were assessed. Results. MiLEP was performed in 15 patients with a median age of 67 years (IQR 62.5; 69.5), prostate volume of 61 cc (IQR 46.5; 65.5), and IPSS score was 25.5 (IQR 23.3; 27), Qmax was 5.3 ml/s (IQR 4.5; 9.3). The median duration of the procedure was 42 min (IQR 37; 55), enucleation was 25 min (IQR 21; 28), and morcellation was 7.5 min (IQR 4; 8). Enucleation efficiency was 1.2 g/min (IQR 1; 1.5) and morcellation efficiency was 5.3 g/min (IQR 4.6; 7.7). The median hemoglobin drop was 6.5 g/l (IQR 1.5; 12.8) and the mass of removed tissue was 34 g (IQR 25; 42). The median catheterization and hospitalization time were 2 days (IQR 2; 2.8) and 3 days (IQR 3; 6), respectively. After 1 month, the median IPSS score was 5 (IQR 4; 6; р < 0.001), Qmax was 18.7 ml/s (IQR 18; 21; р < 0.001). Complications were observed in 5 (33.3%) patients (grade I according to Clavien-Dindo). Stress urinary incontinence occurred in 2 (13.3%) patients on the first day after catheter removal, but in none at 1 month after MiLEP. Conclusion. Minimally invasive enucleation of the prostate with a thulium fiber laser can be considered an effective and safe surgical treatment option for patients with BPH.Petov V.S., Dymov A.M., Azilgareeva С.R., Mustafin M.A., Enikeev M.E., Sukhanov R.B., Li Yu.A., Chuvalov L.L., Tsarichenko D.G., Gazimiev M.A., Rapoport L.M., de Figueiredo F.C.A.
Keywords
BPH
minimally invasive laser enucleation of the prostate
MiLEP
Thulium fiber laser
TFL
About the Authors
Corresponding author: V.S. Petov – Ph.D., urologist, assistant, Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University) of the Ministry of Health of Russia (Sechenov University), Moscow, Russia, e-mail: pettow@mail.ruSimilar Articles
