ENDOSCOPIC ENUCLEATION OF THE PROSTATE – A NEW STANDARD IN SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

Abstract

The latest guideline of the European Association of Urology (2016) for the management of lower urinary tract symptoms has a new term – endoscopic enucleation of the prostate. This term was introduced after the publication of latest meta-analyses showing that both laser enucleation and electroenucleation are effective in the treatment of infravesical obstruction caused by benign prostatic hyperplasia (BPH).Objective: to compare the methods of electroenucleation and laser enucleation (holmium and thulium) of the prostate according to the literature data and own observations.Materials and methods. A total of 624 patients with BPH were included in the study; of them, 459 participants underwent holmium laser enucleation (HoLEP), 35 – monopolar enucleation, and 130 – thulium laser enucleation (ThuLEP). All patients were followed up for one month. We assessed the International Prostate Symptom Score (IPSS), patients’ quality of life (QoL), peak flow rate (Qmax), and residual urine volume prior to surgery and 1 month after it.Results. Functional characteristics have significantly improved by one month post surgery in all three groups. Moreover, the data obtained indicate similar efficacy of different endoscopic enucleation methods. None of the tested parameters demonstrated significant difference across the groups (p >0.05)Conclusions. Our results of HoLEP and ThuLEP suggest high efficacy of these surgical techniques and low number of postoperative complications, which correlates with literature data and guidelines of the European Association of Urology. Monopolar enucleation of the prostate is as effective as ThuLEP or HoLEP; however it has higher frequency of postoperative complications.

Keywords

• thulep
• holep
• laser enucleation
• monopolar enucleation
• removal of prostate adenoma
• infravesical obstruction
• benign prostatic hyperplasia