Long-term Reinterventions after Thulium Laser Enucleation of the Prostate: 12-Year Experience with more than 1000 Patients

Britta Grüne; Fabian Siegel; Frank Waldbillig; Daniel Pfalzgraf; Gaetan Kamdje Wabo; Jonas Herrmann; Maximilian C Kriegmair; Philipp Nuhn; Maurice Stephan Michel; Jost von Hardenberg

doi:10.1016/j.euf.2021.12.006

Long-term Reinterventions after Thulium Laser Enucleation of the Prostate: 12-Year Experience with more than 1000 Patients

Eur Urol Focus. 2022 Sep;8(5):1370-1375. doi: 10.1016/j.euf.2021.12.006. Epub 2022 Jan 10.

Affiliations

¹ Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: britta.gruene@umm.de.
² Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany; Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
³ Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
⁴ Department of Urology, Heilig-Geist-Hospital Bensheim, Bensheim, Germany.
⁵ Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.

PMID: 35016861
DOI: 10.1016/j.euf.2021.12.006

Abstract

Background: Thulium laser enucleation of the prostate (ThuLEP) is an established treatment option for benign prostatic enlargement (BPE), but long-term outcomes have not yet been reported.

Objective: To prove the durability of ThuLEP by investigating its long-term efficacy and morbidity.

Design, setting, and participants: All patients who underwent ThuLEP at a German tertiary referral center between 2009 and 2021 were retrospectively followed up for reinterventions for persistence or regrowth of prostate adenoma (ReIP) or long-term complications (ReIC).

Intervention: ThuLEP.

Outcome measurements and statistical analysis: We calculated the cumulative incidence for ReIP and ReIC at 10 yr. Univariate and multivariate Cox regression models were constructed to identify predictors of ReIP and ReIC.

Results and limitations: Overall, 1097 patients underwent ThuLEP. The median overall follow-up was 6.0 yr (interquartile range [IQR] 2.4-9.2). For one-third of patients (n = 369), median follow-up of 10 yr (IQR 9.1-11.2) was available. A total of 42 patients (3.8%) underwent ReIP after a median of 2 yr (IQR 0.3-4.9). The rate of long-term ReIC was 2.6% (n = 29) and the median time to ReIC was 0.5 yr (IQR 0.3-1.7). The most frequent ReIC was urethrotomy (n = 16, 1.5%). The cumulative incidence of ReIP and ReIC at 10 yr was estimated at 5.6% and 3.4%, respectively. Enucleation weight ≥60 g was a significant predictor of ReIP (hazard ratio 1.2, p = 0.014). The retrospective study design and the lack of functional outcomes are the main limitations.

Conclusions: ThuLEP is a durably effective and safe procedure with low reintervention rates within 12 yr.

Patient summary: This study investigated long-term outcomes of thulium laser enucleation of the prostate for benign enlargement of the prostate (BPE). Low rates of repeat treatment for BPE recurrence or for other complications were observed. Our results show the safety and efficacy of this treatment over a period of 12 years.

Keywords: Follow-up studies; Laser therapy; Lower urinary tract symptoms; Male urologic surgery; Morbidity; Prostatic hyperplasia; Reoperation.

MeSH terms

Humans
Lasers, Solid-State* / therapeutic use
Male
Prostate
Prostatic Hyperplasia* / surgery
Retrospective Studies
Thulium / therapeutic use
Treatment Outcome

Substances

Thulium