Laser Vaporization of the Prostate

Dr. Gianduzzo presented his early results with Thulium laser prostatectomy at the Annual Scientific Meeting of the Urological Society of Australia and New Zealand earlier this year. Read the abstract here. Early Experience of Thulium Laser Vaporization of the Prostate Tony D. Gianduzzo Sunshine Coast Private Hospital, Buderim, Australia. Introduction & Objectives: Thulium laser prostatectomy has been shown to have short and medium-term results equivalent to TURP, with less bleeding and shorter hospitalisation. This observational study evaluated the outcomes of Thulium vaporization of the prostate (ThuVAP) with a 180 Watt Thulium laser in the management of BPH in 30 patients in a community Urological practice over a 6 month period in 2011. Methods: Patients who otherwise were considered suitable for TURP were treated with ThuVAP, utilising a 24.5Fr laser resectoscope and a side-fire laser fibre, supplemented with an end-fire fibre in larger prostates. Results: 30 patients with BPH were treated, with 28 discharged from care to date. The indications included 18 patients with uncomplicated lower urinary tract symptoms (LUTS), with the remainder catheter dependent (7), in chronic retention (3), or undergoing revision surgery (2). Overall, average age was 74 years (49-93), and mean prostatic volume was 71cc (29-240) including two glands over 200 cc. The largest prostate treated was 240cc, with an operative time of 115 minutes. No patient required ancillary procedures to control intraoperative bleeding. Most patients were discharged on the first postoperative day (0-2). One patient (the second case in the series) required later revision surgery for residual apical adenoma, reflecting an initial learning curve. None of the 30 patients required transfusion, and no other significant complications occurred. Considering the subgroup of 18 patients with LUTS, catheters were removed within 6 hours of the procedure in 16. Average IPSS symptom scores improved from 23.9 to 6.0, and bother scores improved from 4.6 to 1.0 at an average follow up time to discharge of 4 weeks (2-12). Conclusions: Thulium laser vaporization of the prostate using a 180 Watt laser is efficacious, with minimal bleeding, and with a short duration of catheterisation and hospitalisation. The learning curve appears short for practitioners experienced in TURP as the technique is largely similar to that of TURP. Additionally, the safety offered by lack of laser overshoot, along with the ability to operate in cases with significant mucosal contact bleeding facilitates transition from TURP to ThuVap. Thulium laser vaporization of the prostate in glands of over 200 cc is achievable, with acceptable operative times and next-day discharge.