Mechanical dissection-based enucleation versus laser energy-based enucleation during thulium laser enucleation of a large prostate: A prospective randomized analysis.

OBJECTIVE

This study attempted to compare the laser energy-based enucleation with the mechanical dissection-based enucleation regarding the enucleation efficiency and the functional outcomes.

METHODS

This was a prospective multicenter study including patients with a prostate exceeding 80 g. Thulium laser enucleation of the prostate was conducted using a high-power thulium laser either through mechanical dissection-based enucleation (Group A) or through laser energy-based enucleation (Group B) according to the preoperative randomization. In Group A, the resectoscope sheath beak was used to liberate the prostate adenoma and laser energy was reserved for adhesions and for hemostasis. In Group B, laser energy was implemented throughout the procedure.

RESULTS

Groups A and B included 68 and 71 patients, respectively, for analysis. The mean (standard deviation [SD]) enucleation time was shorter in Group A than in Group B (55.2 [SD 9.4] min vs. 77.3 [SD 12.5] min, p=0.021). The enucleation efficiency and total operative time were statistically different between the two groups (p=0.032 and 0.039, respectively). Black eschars were observed in 21% of Group A and 100% of Group B. A larger percentage of Group B (35%) expressed more storage symptoms in the first 3 months after surgery than that of Group A (13%). There was no statistically significant difference between the two groups regarding the postoperative transient stress urinary incontinence. Additionally, there was no statistically significant difference between the two techniques regarding the overall bleeding, or the hospital stay in patients on antiplatelet or anticoagulant therapy.

CONCLUSION

Both mechanical dissection-based and laser energy-based thulium laser enucleation of the prostate are safe and feasible for successful reduction of bladder outlet resistance. The mechanical dissection-based enucleation technique provides higher enucleation efficiency with lower postoperative transient storage symptoms.