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Lasers in Transurethral Enucleation of the Prostatea??Do We Really Need Them
摘要： The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
关键词： AEEP,Holmium,LBO,EEP,GreenLEP,Thulium,ThuLEP,Greenlight,Vapoenucleation,ThuVEP,laser,HoLEP,diode
更新于2025-09-23 15:21:01
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Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience
摘要： Bleeding is the most common complication of transurethral resection of the prostate and simple open prostatectomy, especially in men on antiplatelet/anticoagulant therapy. The present study aimed to evaluate the safety and effectiveness of thulium laser vapoenucleation of the prostate (ThuVEP) for benign prostatic hyperplasia in patients on chronic antithrombotic medications. Between January 2015 and December 2019, 88 men underwent the procedure under antithrombotic agents in our center. The mean age was 74.7 ± 6.1 years. Median prostate volume was 66.5 mL. Patients on oral anticoagulants were bridged to low-molecular-weight heparin (n = 35). Aspirin (n = 39), clopidogrel (n = 10), and ticlopidine (n = 4) were maintained. Of the patients, 69.3% had an American Society of Anesthesiologists score ≥ 3. Blood loss at 24 h was comparable in all groups. Median catheterization length and postoperative stays were 2 and 3 days respectively. Acute cardiovascular events occurred in 2 patients (2.3%). Of the patients, 4 required prolonged bladder irrigation, 2 required blood transfusions, 1 required a cystoscopy for bleeding control, and 1 required a suprapubic cystostomy for blood clot evacuation. No patients died within 30 days of being discharged. Late complications occurred in 3 (3.8%) patients (1 optical urethrotomy and 1 bladder neck incision for stenosis; 1 acute myocardial infarction). All follow-up visits (1, 6, and 12-month) showed a significant improvement in all urinary parameters compared to baseline. ThuVEP appears to be a feasible surgical option in high-risk patients on antithrombotic regimens, with acceptable postoperative morbidity, good functional outcome, and low incidence of medium-term reoperation rate.
关键词： aging,postoperative complications,intraoperative complications,prostatectomy,laser therapy,platelet aggregation inhibitors,ThuVEP,benign prostatic hyperplasia,anticoagulants
更新于2025-09-23 15:19:57
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State of the art of Thulium laser enucleation and vapoenucleation of the prostate: a systematic review
摘要： Tm:YAG laser operates at a wavelength of 1940-2013 nm in a continuous wave mode, which enables smooth incision and rapid vaporization of prostatic tissue, with a shallow penetration of only 0.2 mm. These characteristics make Tm:YAG a versatile laser, allowing the surgeon to perform resection, vaporization, and vapoenucleation. This systematic review aims to summarize the current evidence of safety and efficacy, long-term durability, impact on sexual function following Tm:YAG laser enucleation and vapoenucleation of the prostate and to compare the outcomes of these procedures versus other surgical treatments of benign prostatic hyperplasia.
关键词： ThuVEP,ThuLEP,prostatic,laser therapy,complications,patient outcome assessment,hyperplasia
更新于2025-09-12 10:27:22
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Thulium laser enucleation of the prostate
摘要： Various, more minimally invasive laser-based procedures have been introduced into clinical practice for the treatment of symptomatic benign prostatic obstruction (BPO) during the past 20 years as alternatives to open prostatectomy and transurethral resection of the prostate to decrease perioperative morbidity and to achieve comparable outcomes. The most prominent role played the frequency-doubled neodymium:yttrium–aluminium–garnet (YAG) laser or GreenLight laser and the holmium:YAG laser. Since the introduction of holmium laser enucleation of the prostate (HoLEP) in 1998, this procedure has gained worldwide acceptance because of complete dissection of the prostate adenoma from the prostatic pseudocapsule. HoLEP has been proven to be a size-independent, well tolerated and efficient procedure with excellent long-term outcomes. The shallow learning curve of the HoLEP technique has, however, limited its widespread use. A learning curve of at least 25–50 cases was found acceptable using a structured mentorship programme. On the basis of HoLEP, a wide array of so-called ‘me too’ laser-based transurethral enucleation techniques have been described during the past 12 years using diode, GreenLight and thulium lasers, of whom the latter played the most prominent role. Thulium:YAG vapoenucleation of the prostate (ThuVEP) has been found to be a size-independent, well tolerated and effective procedure with low-perioperative morbidity and excellent long-term results. The durability of ThuVEP was demonstrated by a prostate-specific antigen (PSA)-reduction rate of 77.1% at 5-year follow-up. The completeness of adenoma removal by ThuVEP was currently confirmed by a retrospective matched-paired comparison between ThuVEP and thulium vaporesection of the prostate (ThuVARP): the PSA-reduction was significantly higher after ThuVEP compared with ThuVARP (78.9 vs. 23.4%) at 24-month follow-up, which may lead to a higher reoperation rate after ThuVARP during long-term follow-up.
关键词： Thulium laser enucleation,BPO,ThuVEP,prostate,HoLEP
更新于2025-09-12 10:27:22