Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up.

OBJECTIVE: To compare the clinical outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and plasmakinetic bipolar resection of the prostate (PKRP) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial with 18 months of follow-up.

METHODS: The study randomized 158 consecutive patients with BPH to ThuLEP (n = 79) or PKRP (n = 79). All patients were evaluated preoperatively and at 1, 3, 6, 12, and 18 months after surgery by International Prostate Symptom Score (IPSS), quality of life score (QOLS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR).

RESULTS: The 79 patients in each study arm each showed no significant difference in preoperative parameters. Compared with PKRP, ThuLEP required a longer operation time (65.4 vs 47.4 minutes, P = .022) but resulted in less hemoglobin decrease (0.15 vs 0.30 g/dL, P = .045). ThuLEP also needed less catheterization time (2.1 vs 3.5 days, P = .031), irrigation volume (12.4 vs 27.2 L, P = .022), and hospital stay (2.5 vs 4.6 days, P = .026). During the 1, 3, 6, 12, and 18 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS.

CONCLUSION: ThuLEP and PKRP both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to PKRP in blood loss, catheterization time, irrigation volume, and hospital stay but inferior to PKRP in operation time. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through the 18 months of follow-up.