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Re: Long-term Results of Thulium Laser Resection of the Prostate: A Prospective Study at Multiple Centers

  • Hao Yan 1,
  • Jing Li 1,
  • Xin Cui 1,
  • Tong-wen Ou 1
1 Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China

Publication: European Urology

PII: S0302-2838(15)01025-8

DOI: 10.1016/j.eururo.2015.10.033

Sun F, Han B, Cui D, et al
World J Urol 2015;33:503–8
Experts’ summary:
In a retrospective, long-term, multisite study, Sun and colleagues demonstrated the safety, efficiency, and durability of thulium laser resection of prostate (TmLRP) in the treatment of benign prostatic hyperplasia (BPH). Of 2216 patients recruited at four medical centers, 541 (24.4%) were available for the longest follow-up period (8 yr). Compared with baseline, there were significant improvements in International Prostate Symptom Score, maximum urinary flow rate, quality of life, and postvoid residual urine by 3 mo after surgery and throughout the 8-yr follow-up period. Long-term complications were noted in 122 patients (5.5%): 58 (2.6%) had urethral stricture, 35 (1.6%) had bladder neck contracture, 2 (0.1%) had persistent stress incontinence, and 27 (1.2%) had BPH recurrence.
Experts’ comments:
The safety and efficacy of TmLRP as a minimally invasive procedure for the surgical treatment of BPH has been demonstrated by many clinical trials [1]. Compared with transurethral resection of the prostate (TURP), TmLRP has been shown to be superior with respect to hemostasis [2]. As emphasized by the authors, however, the evidence regarding the long-term safety and efficacy of TmLRP is limited. Consequently, we congratulate the authors for conducting this study, which aimed to evaluate the long-term durability of TmLRP.

Nevertheless, we would like to point out a few issues. First, although it has been shown that short-term resolution of symptoms is not associated with the percentage of prostate volume removed [3], many urologists still believe that, in the long-term, the resolution of symptoms is associated with the extent of resection [4]. Based on our experience with TURP and TmLRP, the loop electrode used for TURP easily removes more tissue and makes the surgical margin more regular compared with the laser fibers used for TmLRP, especially during resection of the part of the media lobes below the verumontanum level. This is due to the different shape of the instrument used in TmLRP and TURP. We speculate that less tissue will be removed with TmLRP, and thus the long-term results of TmLRP would be worse than TURP. Future studies should directly evaluate the long-term outcomes of TURP versus TmLRP, and the residual prostatic weight and prostate-specific antigen levels should be included in the assessments.

Second, this study is significantly limited by the fact that a large number of patients were lost to follow-up (75.6% at 8 yr); however, if the main reasons for the number of patients lost to follow-up were listed in the article, then it would be helpful in interpreting the results and drawing more convincing conclusions about the durability of TmLRP.

In summary, we agree with the authors that TmLRP is a safe and effective procedure, but the long-term durability of TmLRP requires additional research.

  • [1] Y. Zhu, J. Zhuo, D. Xu, et al. Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol. 2015;33:509-515 Crossref
  • [2] S.J. Xia, J. Zhuo, X.W. Sun, et al. Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol. 2008;53:382-389
  • [3] O.W. Hakenberg, C. Helke, A. Manseck, M.P. Wirth. Is there a relationship between the amount of tissue removed at transurethral resection of the prostate and clinical improvement in benign prostatic hyperplasia. Eur Urol. 2001;39:412-417 Crossref
  • [4] A. Bachmann, M. Rieken. Words of wisdom. Re: GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostate hyperplasia: a randomized controlled study. Eur Urol. 2015;67:976 Crossref