Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: results at a single institution

Andreas J Gross, Christopher Netsch, Sophie Knipper, Jasmin Hölzel, Thorsten Bach
European Urology 2013, 63 (5): 859-67

BACKGROUND: Thulium vapoenucleation of the prostate (ThuVEP) has been introduced as a minimally invasive treatment for benign prostatic obstruction (BPO).

OBJECTIVE: To analyze immediate outcomes and the institutional learning curve of ThuVEP, and to report its standardized complication rates, using the modified Clavien classification system (CCS) to grade perioperative complication rates.

DESIGN, SETTINGS, AND PARTICIPANTS: A prospective evaluation of 1080 patients undergoing ThuVEP from January 2007 until May 2012 at our institution.

INTERVENTION: ThuVEP was performed using the 2-μm, continuous-wave, thulium:yttrium-aluminum-garnet laser.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Preoperative status, surgical details, and immediate outcome were recorded for each patient. Perioperative complications were classified according to the modified CCS.

RESULTS AND LIMITATIONS: Median prostate size was 51 ml (interquartile range [IQR]: 36-78.7). Median operation time was 56 min (IQR: 40-80), and median enucleation time was 32.5 min (IQR: 22-50). Median catheterization time was 2 d (IQR: 2-2); median length of hospital stay was 4 d (IQR: 3-5). Median resected tissue weight was 30 g (IQR: 16.00-51.25). Incidental carcinoma of the prostate was detected in 59 (5.5%) patients. Median maximum urinary flow rate (8.9 vs 18.4 ml/s) and postvoid residual urine volume (120 vs 20 ml) changed significantly (p<0.001). Minor complications occurred in 24.6% of the patients (Clavien 1: 20.8%; Clavien 2: 3.8%). Early reinterventions were necessary in 6.6% of the patients (Clavien 3a: 0.6%; Clavien 3b: 6%). One Clavien 4 complication occurred (0.09%). The overall complication rates decreased significantly over time due to decreasing Clavien 1, 2, and 3b events. The major limitations of the study are the prospective, unicentric study design, the lack of a control group, and that only short-term data were documented on morbidity and efficacy of the ThuVEP procedure.

CONCLUSIONS: ThuVEP is a safe and effective procedure for the treatment of symptomatic BPO, with low perioperative morbidity.

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