Low-power ThuLEP shows promise in patients with BPH

Low-power (30 W) thulium laser enucleation of the prostate (ThuLEP) demonstrated feasibility and efficacy in patients with benign prostatic hyperplasia (BPH), according to data from a prospective observational study (NCT05494944) published in the Central European Journal of Urology.¹

Significant decreases from baseline in IPSS, PSA, and PVR were observed at 1-, 3-, and 6-month follow-up.

Overall, the study included 80 patients with BPH who underwent low-power ThuLEP between December 2019 and March 2022. All patients had prostates greater than 80 mL and had not responded to prior medication therapy. Patients were excluded from the study if they had a history of bleeding, prostate cancer, failed transurethral prostate surgery, neurogenic bladder, or urethral strictures.²

Investigators collected data on patients’ prostate size, prostate-specific antigen (PSA), enucleation and morcellation times, postoperative International Prostate Symptom Score (IPSS), and International Index of Erectile Function-5 (IEFF-5) records at 1-, 3-, 6-, and 12-months following surgery.

The average age of participants was 66.7 ± 6.4 years. The mean prostate volume was 112.65 ± 19.3 mL, and the mean duration for enucleation was 71 ± 11 min. Overall, the average length of stay in the hospital was 1.19 days, and 80% of patients had their catheters removed on the first day.

Data also showed that at 1 month, the mean IPSS score enhancement was 8.012 ± 1.78 mL. The mean Q_max progress was 30.16 ± 4 mL s-1, and post-void residual (PVR) was 37.78 ± 9.6 mL. A notable improvement in dysuria was also observed, with only 4 (5.4%) patients having dysuria and urge incontinence at initial follow-up. By 3 months, all cases had completely resolved.

At 6-month follow-up, the average PSA level decreased by 1.81 ± 0.63 mg dL-1. The mean decrease in hemoglobin level was 1.81 ± 0.63 mg dL-1.

Significant decreases from baseline in IPSS (P < .001), PSA (P < .001), and PVR (P < .001) were observed at 1-, 3-, and 6-month follow-up. Further, the investigators noted a significant rise in Qmax throughout 6 months. A significant decrease in IIEF score was noted at 3 months following surgery (P = .027), but no significant change was observed from baseline to 12 months following surgery (P = .554).

At 12-month follow-up, the investigators observed improvements in postoperative urgency and urgency urinary incontinence compared with baseline (P = .005). No substantial differences in IIEF-5 scores were observed. There were no re-interventions noted for recurrence at 12 months, nor any instances of urethral stricture or bladder neck contracture.

Based on these findings, the authors wrote, “Low-power ThuLEP is worthwhile for therapeutic use because it effectively treats patients with large prostates with satisfactory urinary and sexual effects.”

However, they note that further studies are still necessary.

They concluded, “Further studies are needed on a large scale; one of the restrictions of our study was its small sample size owing to the COVID pandemic. In addition, further randomized studies are needed to compare low-power versus high-power ThuLEP and confirm the non-inferiority of low-power ThuLEP as a minimally invasive surgery with lower costs and reduced postoperative urinary and sexual negative impact.”

Reference

1. Morsy S, Kamal I, Meshref A, Abdel-Mohsen M, Abdel-Hakim M, Yehia A. Surgical outcomes of low-power thulium laser enucleation of prostates >80 g. One-year of follow-up. Cent European J Urol. 2023;76(3):193-198. doi:10.5173/ceju.2023.50

2. Low power ThuLEP for prostate size more than 80 gm. ClinicalTrials.gov. Last updated August 12, 2022. Accessed December 13, 2023. https://clinicaltrials.gov/study/NCT05494944