Functional Outcomes and Safety Profile of Thulium: YAG Laser Enucleation (ThuLEP) versus Robot-Assisted Simple Prostatectomy (RASP) Facing Very Large (≥ 150 Ml) Prostates - Beyond the Abstract
In our study, patients with surgical indication for BPH and a very large prostate, defined as volume ≥ 150 ml, underwent enucleation of the prostate using Thulium:YAG laser (ThuLEP, Group A) versus transvesical robot-assisted simple prostatectomy (RASP, Group B). Patients from Group A were operated on by expert endourologists, whereas those from Group B were treated by expert robotic surgeons. The choice of treatment was based on the patients’ preference after adequate counselling. Intraoperative and postoperative data were collected. All patients were followed for 3 years with no missing data. Presence of urgency, urge incontinence, and stress incontinence was recorded at both 3 and 6 months.
Mean operative time was in favour of RASP (82.7 vs. 66.3 min, p=0.04). On the contrary, ThuLEP outperformed RASP in mean length of stay (2.5 vs. 4.8 days, p=0.04) and mean catheterization time (3.5 vs. 7.3 days, p=0.05). On the first POD, a mean Hb decrease of 0.7 g/dl and 1.3 g/dl was recorded in Group A and Group B (p=0.06). Functional outcomes were comparable between the two groups, even after 3 years. Urinary tract infections were more frequent after RASP (4.0% vs. 8.0%, p=0.05). Four patients (4.0%) from Group A and 9 (9.0%) from Group B (p=0.04) underwent clot-induced acute urinary retention. After ThuLEP, the rate of stress incontinence (6.0% vs. 4.0%, p=0.06), urgency (12.0% vs. 4.0%, p=0.04), and urge incontinence (3.0% vs. 0%, p=0.04) was higher.
Our study shows that ThuLEP and RASP are both reliable options for patients with prostate volume ≥ 150 ml. RASP allows a faster procedure, while ThuLEP offers shorter hospitalization, sooner catheter removal, and lower blood loss. Complication rates are different, with more frequent infection and acute urinary retention after RASP and higher rates of temporary urgency, stress, and urge urinary incontinence after ThuLEP. The choice of treatment should be made according to the available equipment and the surgeon’s proficiency.
Written by: Davide Perri, MD, Department of Urology, Division of Urology, Azienda Socio Sanitaria Territoriale Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
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