Maliszewski Tomasz, Sikorski Andrzej1.
Department of Urology, Uomed Hospital,Koszalin, PL ; 1Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, PL
To report 4-years follow-up results of clinical trial comparing diode laser enucleation of the prostate (DiLEP) with diode laser vaporisation of the prostate (DLVAP).
Materials and Methods:
A total of 151 consecutive patients were included in the prospective study who had received laser treatment for BPH. Patients were assigned to two groups based on the type of procedure: 106 to DiLEP group and 45 to DLVAP group. Patients with a history of neurogenic bladder dysfunction, chronic prostatitis or bladder cancer were excluded from evaluation. Standard follow-up examinations were performed in both study groups in predefined time points (in the perioperative period, at month 1 and month 3, and month 6, and then every year). Primary endpoints included: lower urinary tract symptoms (LUTS) as measured by the International Prostate Symptom Score (IPSS), urinary flow rates and post-void residual urinary volume. Complications were assessed.
An additional endpoint was to review video records to precisely determine the time-frames for individual surgical procedures and to plot the learning curve.
All the remaining 151 patients had undergone the 4-year follow-up assessment. Measurements were performed at 1,3,6,12,24,36 and 48 months. There were no statistically significant differences in baseline characteristics between the two groups. No significant intraoperative and early postoperative bleeding was observed. Hospital stay after surgical intervention covered 1 day, that was equal to average time of urethral catheter indwelling. The improvement rates, calculated based on the IPSS scores at 4 years after surgery, were 78.9% and 60.5% in the DiLEP and DLVAP group, respectively. The results indicate significant decrease in severity of LUTS. The sustained treatment effect was in favor of DiLEP intervention group. Also treatment efficacy was better in the DiLEP group compared to the DVLAP group, as regards the maximum urinary flow rate (Qmax). The difference was statistically significant.
Diode laser enucleation and vaporisation of the prostate are low-risk minimally-invasive treatment option of treatment of patients with BPH. Both methods may be safely performed even in high risk and patients on ongoing oral anticoagulation. Treatment effects are better and more sustained with laser enucleation than with laser vaporization of the prostate. DiLEP is a true endourological alternative to TURP. Thus, these results comparing DiLEP versus DLVAP with the high power diode laser is the first clinical study in literature.
Key Words: prostate, enucleation, ablation techniques, lasers, prostatic hyperplasia