Thulium laser incision of prostate with selective median lobe vaporesection versus water vapor thermal therapy in the treatment of benign prostatic obstruction with ejaculation-sparing intent: a retrospective, comparative analysis from two institutions.

PURPOSE: To compare thulium laser incision of prostate (ThuIP) versus water vapor thermal therapy (Rezum) in the treatment of benign prostatic obstruction (BPO) with ejaculation-sparing intent in a retrospective analysis of cohorts treated at different institutions and during different time intervals.

METHODS

Data of patients who underwent surgery for BPO were retrospectively collected and analyzed from two independent cohorts. The ThuIP cohort corresponds to a previously published single-arm series and included selective vaporesection of the median lobe when obstructing (27%). The comparative study design was conceived a posteriori, and only patients with complete 12-month follow-up were included. Pre, intra, and post-operative data were compared. Functional and patient-reported outcomes were compared at 6 and 12 months follow-up.

RESULTS

120 and 81 patients underwent ThuIP and Rezum, respectively. Operative time (15 vs 10 min, p < 0.001) and LOS (3 vs 2 days, p < 0.001) were longer for ThuIP, while Rezum showed a prolonged catheterization time (2 vs 7 days, p < 0.001). Rezum was associated with a higher percentage of transient acute urinary retention (3.4% vs 13.6%, p = 0.006). One patient in the ThuIP group developed a Clavien-Dindo grade IIIa complication. ∆IPSS favored ThuIP during follow-up (p < 0.001 and p = 0.001 at 6 and 12 months, respectively), while ∆Qmax favored ThuIP at 6 months (p < 0.001), but not at 12 months (p = 0.07). Both procedures were effective in sparing ejaculation (88% vs 93%, p = 0.3). At multivariate analysis, age was identified as an independent predictor of the absence of antegrade ejaculation (OR 1.07, p = 0.008).

CONCLUSIONS

ThuIP and Rezum are viable alternatives for achieving de-obstruction with a high chance of ejaculation preservation; in this retrospective comparison of cohorts treated in different settings, ThuIP provides higher improvement in patient-reported outcomes and faster improvement in functional outcomes, while Rezum appears to be a slightly faster and less invasive procedure.