Mechanical dissection-based enucleation versus laser energy-based enucleation during thulium laser enucleation of a large prostate: A prospective randomized analysis
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Thulium laser has been widely used for treating large benign prostatic adenoma owing to the precise tissue incision and excellent hemostasis. Nevertheless, extensive laser energy utilization could cause tissue carbonization and harm to the adjacent tissues. This study attempted to compare the laser energy-based enucleation with the mechanical dissection-based enucleation regarding the enucleation efficiency and the functional outcomes. This was a prospective multicenter study including patients with prostate exceeding 80 g. Thulium laser enucleation of the prostate was conducted using high power thulium laser either through mechanical dissection-based enucleation (Group A) or laser energy-based enucleation (Group B) according to the preoperative randomization. In Group A, the resectoscope sheath beak was used to liberate the prostate adenoma and laser energy was reserved for adhesions and for hemostasis. In Group B, laser energy was implemented throughout the procedure. Groups A and B included 71 and 72 patients, respectively. The mean enucleation time was shorter in Group A (55.2 min with standard deviation [SD], 9.4 min) than in Group B (77.3 min with SD 12.5 min). The enucleation efficiency and total operative time were statistically different between the two groups ( p =0.032 and 0.039, respectively). The black eschars were observed in 21% of Group A and 100% of Group B. A larger percent of Group B (35%) expressed more storage symptoms in the first 3 months after surgery than Group A (13%). There was no statistically significant difference between the two groups regarding the postoperative stress urinary incontinence. Additionally, there was no statistically significant difference between the two techniques regarding the postoperative bleeding, and the hospital stay in patients on antiplatelet or anticoagulation therapy. Both techniques of enucleation are safe and feasible for successful reduction of bladder outlet resistance. The mechanical dissection dependant enucleation technique provides higher enucleation efficiency with lower postoperative transient storage symptoms.
Source: Asian journal of urology
Authors: Ahmed Assem, Wahed Fawzy, Islam Nasser Abd Elaziz, Samer Morsy, Islam Kamal, Ahmed Abdalla Ashmawy
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Funder: Tongji University
OpenAlex ID: W4407418138