Thulium vapoenucleation found safe, efficacious in BPH

Hamburg, Germany-Thulium vapoenucleation of the prostate (ThuVEP) provided significant and durable symptomatic improvement in benign prostatic obstruction, long-term follow-up of a clinical series showed.

Average peak urinary flow (Qmax) doubled immediately after treatment and continued to increase during the first year of follow-up in 124 men. The improvement observed at 12 months was maintained at 48 months (7.6 mL/sec vs. 20 mL/sec). Improvement in post-void residual (PVR) volume followed a similar pattern, as did International Prostate Symptom Score (IPSS) and quality of life.

ThuVEP proved safe intraoperatively and during long-term follow-up, as no complication affected more than 6.5% of patients, and most occurred in fewer than 5% of patients, as reported at the AUA annual meeting in San Diego.

“Thulium vapoenucleation is a safe, efficacious, and durable procedure for the treatment of symptomatic BPO,” said first author Christopher Netsch, MD, a urologist at Asklepios Klinik Barmbek in Hamburg, Germany. “The incidence of late complications with thulium vapoenucleation was very low.”

The findings came from a group of men treated with ThuVEP during 2007 and 2008. The patients had a mean age of 71 years and mean prostate volume of 58 cc. Total procedural time averaged 74 minutes, including 32.5 minutes for enucleation, during which an average of 25 grams of tissue was resected.

The mean Qmax increased from 7.6 mL/sec at baseline to 15.4 mL/sec at discharge, which occurred within 24 hours in all cases (p<.001). Mean PVR declined from 107.5 mL to 20 mL at discharge (p<.001).

Long-term improvements in Qmax, PVR

At the 12-month follow-up, mean Qmax had increased to 21 mL/sec and stayed at that level during long-term follow-up (p=.001). PVR ranged between 10 mL and 15 mL during follow-up from 12 to 36 months and stood at 25 mL at the 48-month evaluation (p=.001).

The mean International Prostate Symptom Score improved from 21 at baseline to 3 at 12 months and remained at 4 after 48 months (p=.001). Global QoL score averaged 5 at baseline, declined to 1 at 12 months, and remained at 1 through the remainder of follow-up (p=.001).

Dr. Netsch reported that nine patients (7.3%) required second-look procedures in the immediate postoperative period. Reasons were failed morcellation in two cases, clot retention in three, and residual tissue at the apex of the prostate in four.

Early postoperative complications consisted of acute urinary retention in eight patients (6.5%), clot retention without surgical revision and residual prostate adenoma in four cases each (3.2%), urinary tract infection (UTI) with signs of bacteremia and hemorrhage requiring coagulation in three cases each (2.4%), blood transfusion and incomplete morcellation in two cases each (1.6%), and a ureteric orifice injury in one patient that required transient use of a double-J stent.

The list of complications at 48 months comprised seven cases of UTI, two cases each of epididymitis and bladder neck sclerosis, and one case of urethral stricture.

None of the patients required repeat treatment during follow-up, Dr. Netsch said.UT

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