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Thuliumvapoenukleation der Prostata bei Prostatavolumina > 80 ml mit einem 1,9-µm- oder 2-µm-Thuliumlaser

Frühfunktionelle Ergebnisse aus 2 Zentren

Thulium vapoenucleation of prostates larger than 80 ml using a 1.9-µm and a 2-µm thulium laser

Early perioperative results from two centres

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Zusammenfassung

Hintergrund

Zahlreiche Studien zeigen, dass die Thuliumvapoenukleation (ThuVEP) der Prostata ein größenunabhängiges, minimal-invasives Verfahren zur Therapie der benignen Prostatavergrößerung darstellt. Bislang wurden alle Studien mit einem 2-µm-Thuliumlaser durchgeführt. Ziel der vorliegenden Arbeit war es, Komplikationen und frühfunktionelle Ergebnisse zweier Thuliumlaser unterschiedlicher Wellenlängen bei Prostatavolumina > 80 ml zu evaluieren.

Material und Methoden

Eine retrospektive bizentrische Matched-paired-Analyse wurde an 296 Patienten durchgeführt. Basierend auf dem Prostatavolumen wurden je 148 Patienten pro Zentrum und verwendetem Laser gematched. In einem Zentrum wurde ein 2 µm (RevoLix®, LISA Laser products, Katlenburg, Deutschland, n = 148) im anderen ein 1,9 µm (vela® XL, starmedtec, Starnberg, Deutschland, n = 148) Thuliumlaser mit einer Leistung von 90 bzw. 80 W verwendet.

Ergebnisse

Das mediane (interquartile) Prostatavolumen betrug 100 (86,25–120) ml. Bei Entlassung waren Qmax (präoperativ 7,9 und 9 ml/s vs. postoperativ 19,35 und 16,2 ml/s) und Restharn (präoperativ 130 und 45 ml vs. postoperativ 20 und 25 ml) nach 2 µm und 1,9 µm ThuVEP signifikant verbessert (p < 0,001). Die mediane Katheter- und Krankenhausverweildauer lag in beiden Gruppen bei 2 bzw. 4 Tagen. Perioperative Komplikationen traten bei 89 (30,1 %) Patienten auf (Clavien-Klassifikation): Clavien 1 (12,2 %), Clavien 2 (9,1 %), Clavien 3a (0,7 %), Clavien 3b (7,1 %) und Clavien 4a (1 %). Hinsichtlich des Auftretens von Komplikationen wurden keine Unterschiede zwischen den Thuliumlasersystemen festgestellt.

Schlussfolgerungen

Die ThuVEP stellt ist ein sicheres und effektives Verfahren bei Prostatavolumina > 80 ml dar. Sowohl der 1,9- als auch der 2-µm-Thuliumlaser führen zu einer unmittelbaren Verbesserung der Miktion bei niedriger perioperativer Morbidität.

Abstract

Background

Numerous studies have shown that thulium vapoenucleation of the prostate (ThuVEP) is a size-independent minimally invasive procedure for the treatment of benign prostatic enlargement. All ThuVEP series have been performed with a 2-µm thulium laser device so far. The aim of this study was to evaluate the complications and early postoperative results of two thulium-devices with different wavelengths for ThuVEP in prostates larger than 80 ml.

Materials and methods

A retrospective bi-centric matched-paired analysis with 296 patients was performed. Based on prostate size, 148 were matched at each centre and laser device, respectively. A 2-µm (RevoLix®, LISA Laser products, Katlenburg, Germany n=148) and a 1.9-µm (vela® XL, starmedtec, Starnberg, Germany, n=148) thulium laser with a power output of 90 and 80 W was used. Patients’ data were assessed and compared.

Results

The median prostate volume (interquartile) was 100 ml (range 86.25–120 ml). At discharge, Qmax (preoperative 7.9 and 9 ml/s vs. postoperative 19.35 and 16.2 ml/s) and postvoiding-residual urine (preoperative 130 and 45 ml vs. postoperative 20 and 25 ml) were significantly improved after 2-µm and 1.9-µm ThuVEP (p<0.001). The median catheterization time and hospitalization times were 2 and 4 days in both groups. Perioperative complications occurred in 89 patients (30.1%): Clavien 1 (12.2%), Clavien 2 (9.1%), Clavien 3a (0.7%), Clavien 3b (7.1%), and Clavien 4a (1%). Regarding the occurrence of complications, there were no differences between the two thulium devices.

Conclusion

ThuVEP represents a safe and effective treatment for prostates larger than 80 ml. Both thulium laser devices give satisfactory immediate micturition improvement with low perioperative morbidity.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Netsch, T. Knoll, A.J. Gross und G. Wendt-Nordahl geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland

    C. Netsch & A.J. Gross

  2. Abteilung für Urologie, Urologische Klinik Sindelfingen, Sindelfingen, Deutschland

    T. Knoll & G. Wendt-Nordahl

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  1. C. Netsch
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  2. T. Knoll
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  3. A.J. Gross
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  4. G. Wendt-Nordahl
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Correspondence to C. Netsch.

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Netsch, C., Knoll, T., Gross, A. et al. Thuliumvapoenukleation der Prostata bei Prostatavolumina > 80 ml mit einem 1,9-µm- oder 2-µm-Thuliumlaser. Urologe 54, 1414–1420 (2015). https://doi.org/10.1007/s00120-014-3652-8

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  • DOI: https://doi.org/10.1007/s00120-014-3652-8

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