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Dual-centre randomized-controlled trial comparing transurethral endoscopic enucleation of the prostate using diode laser vs. bipolar plasmakinetic for the treatment of LUTS secondary of benign prostate obstruction: 1-year follow-up results

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Abstract

Purpose

Bipolar endoscopic enucleation of the prostate (BEEP) was recommended by the 2016 EAU guidelines as the first choice of surgical treatment in men with a substantially enlarged prostate and moderate-to-severe lower urinary tract symptoms. The main aim of this study was to compare a modified diode laser enucleation of the prostate (DiLEP) to BEEP.

Methods

A total of 114 patients with prostate (20–160 mL) were randomized 1:1 into either DiLEP or BEEP in a dual-centre, non-inferiority-design randomized-controlled trial. The primary outcomes included Qmax and IPSS at 12 months. Non-inferiority was evaluated by comparing the two-sided 95% CI for the mean differences of Qmax and IPSS. Secondary endpoints included other perioperative parameters, postoperative micturition variables, and complication rate.

Results

A total of 111 patients (97%) had completed the intent-to-treat analysis, The results showed that DiLEP was comparable to BEEP regarding Qmax (28.0 ± 7.0 vs. 28.1 ± 7.2 mL/s) and IPSS (3.0 ± 2.2 vs. 2.9 ± 2.6) at 12 months, the non-inferiority was met for both Qmax and IPSS. There were also no significant difference between two groups regarding tissue removal rate (71.8 vs. 73.8%), hemoglobin decrease (0.33 ± 0.66 vs. 0.36 ± 0.75 g/dL), sodium decrease (1.0 ± 2.7 vs. 0.3 ± 2.9 mmol/L), and Clavien III complications (5.3 vs. 1.8%) at 12 months.

Conclusions

This DiLEP is an anatomical endoscopic enucleation technique for the treatment of benign prostatic hyperplasia, it is non-inferior to BEEP regarding Qmax and IPSS at 12 months postoperatively.

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Abbreviations

BPO:

Benign prostatic obstruction

BEEP:

Bipolar plasmakinetic endoscopic enucleation of the prostate

DiLEP :

Diode laser enucleation of the prostate

EEP:

Endoscopic enucleation of the prostate

IIEF-5:

International index of erectile function

IPSS:

International prostate symptom score

LUTS:

Lower urinary tract symptoms

OP:

Open prostatectomy

PSA:

Prostate-specific antigen

PV:

Prostate volume

PVR:

Postvoid residual

Q max :

Maximum urinary flow rate

QoL:

Quality of life

RCT:

Randomized-controlled trial

SCP:

Surgical capsule plane

TURP:

Transurethral resection of the prostate

References

  1. Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KA, Gravas S (2015) 2015 EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109. https://doi.org/10.1016/j.eururo.2014.12.038

    Article  PubMed  Google Scholar 

  2. Roos NPWJ, Malenka DJ, Fisher ES, McPherson K, Andersen TF, Cohen MM, Ramsey E (1989) Mortality and reoperation after open and transurethral resection of the prostate. N Engl J Med 320(17):1120–1124. https://doi.org/10.1056/NEJM198904273201705

    Article  PubMed  CAS  Google Scholar 

  3. Madersbacher S, Lackner J, Brössner C, Röhlich M, Stancik I, Willinger M, Schatzl G (2005) Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol 47(4):499–504. https://doi.org/10.1016/j.eururo.2004.12.010

    Article  PubMed  Google Scholar 

  4. Simforoosh NAH, Kashi AH, Zare S, Tabibi A, Danesh A, Basiri A, Ziaee SA (2010) Open prostatectomy versus transurethral resection of the prostate, where are we standing in the new era? A randomized controlled trial. Urol J 7(4):262–269

    PubMed  Google Scholar 

  5. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58(3):384–397. https://doi.org/10.1016/j.eururo.2010.06.005

    Article  PubMed  Google Scholar 

  6. Rao JM, Yang JR, Ren YX, He J, Ding P, Yang JH (2013) Plasmakinetic enucleation of the prostate versus transvesical open prostatectomy for benign prostatic hyperplasia > 80 mL: 12-month follow-up results of a randomized clinical trial. Urology 82(1):176–181. https://doi.org/10.1016/j.urology.2013.02.032

    Article  PubMed  Google Scholar 

  7. Ou R, Deng X, Yang W, Wei X, Chen H, Xie K (2013) Transurethral enucleation and resection of the prostate vs transvesical prostatectomy for prostate volumes > 80 mL: a prospective randomized study. BJU Int 112(2):239–245. https://doi.org/10.1111/bju.12181

    Article  PubMed  Google Scholar 

  8. Geavlete B, Stanescu F, Iacoboaie C, Geavlete P (2013) Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases—a medium term, prospective, randomized comparison. BJU Int 111(5):793–803. https://doi.org/10.1111/j.1464-410X.2012.11730.x

    Article  PubMed  CAS  Google Scholar 

  9. Chen S, Zhu L, Cai J, Zheng Z, Ge R, Wu M, Deng Z, Zhou H, Yang S, Wu W, Liao L, Tan J (2014) Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: a randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol 66(2):284–291. https://doi.org/10.1016/j.eururo.2014.01.010

    Article  PubMed  CAS  Google Scholar 

  10. Li M, Qiu J, Hou Q, Wang D, Huang W, Hu C, Li K, Gao X (2015) Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One 10(3):e0121265. https://doi.org/10.1371/journal.pone.0121265

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Lin Y, Wu X, Xu A, Ren R, Zhou X, Wen Y, Zou Y, Gong M, Liu C, Su Z, Herrmann TR (2016) Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 34(9):1207–1219. https://doi.org/10.1007/s00345-015-1735-9

    Article  PubMed  Google Scholar 

  12. Herrmann TRW (2016) Enucleation is enucleation is enucleation is enucleation. World J Urol 19(1):19–22

    Google Scholar 

  13. Buisan O, Saladie JM, Ruiz JM, Bernal S, Bayona S, Ibarz L (2011) Diode laser enucleation of the prostate (Dilep): technique and initial results. Actas Urológicas Españolas (English Edition) 35(1):37–41. https://doi.org/10.1016/s2173-5786(11)70010-5

    Article  CAS  Google Scholar 

  14. Xu A, Zou Y, Li B, Liu C, Zheng S, Li H, Xu Y, Chen B, Xu K, Shen H (2013) A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia. J Endourol/Endourol Soc 27(10):1254–1260. https://doi.org/10.1089/end.2013.0107

    Article  Google Scholar 

  15. Lusuardi L, Myatt A, Sieberer M, Jeschke S, Zimmermann R, Janetschek G (2011) Safety and efficacy of eraser laser enucleation of the prostate: preliminary report. J Urol 186(5):1967–1971. https://doi.org/10.1016/j.juro.2011.07.026

    Article  PubMed  Google Scholar 

  16. Mamoulakis C, Efthimiou I, Kazoulis S, Christoulakis I, Sofras F (2011) The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol 29(2):205–210. https://doi.org/10.1007/s00345-010-0566-y

    Article  PubMed  Google Scholar 

  17. Bachmann A, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyere F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitan C, Knispel H, Thomas JA (2014) 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial–the GOLIATH study. Eur Urol 65(5):931–942. https://doi.org/10.1016/j.eururo.2013.10.040

    Article  PubMed  Google Scholar 

  18. Liu C, Zheng S, Li H, Xu K (2010) Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics. J Urol 184(6):2440–2445. https://doi.org/10.1016/j.juro.2010.08.037

    Article  PubMed  Google Scholar 

  19. Zhao Z, Zeng G, Zhong W, Mai Z, Zeng S, Tao X (2010) A prospective, randomised trial comparing plasmakinetic enucleation to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: 3-year follow-up results. Eur Urol 58(5):752–758. https://doi.org/10.1016/j.eururo.2010.08.026

    Article  PubMed  Google Scholar 

  20. Yang SS, Hsieh CH, Chiang IN, Lin CD, Chang SJ (2013) Prostate volume did not affect voiding function improvements in diode laser enucleation of the prostate. J Urol 189(3):993–998. https://doi.org/10.1016/j.juro.2012.08.256

    Article  PubMed  Google Scholar 

  21. Shaobo Zheng CL, Yawen Xu et al (2005) Intraluminal nucleation in transurethral vaporization and electro-resection of the prostate. Chin J Urol 26(8):558–561

    Google Scholar 

  22. Herrmann TR (2016) Long-term outcome after endoscopic enucleation of the prostate: from monopolar enucleation to HoLEP and from HoLEP to EEP. Der Urologe Ausg A 55(11):1446–1454. https://doi.org/10.1007/s00120-016-0245-8

    Article  PubMed  CAS  Google Scholar 

  23. Gilling PJ (1998) Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation preliminary results. Eur Urol 33(1):69–72

    Article  PubMed  Google Scholar 

  24. Lusuardi L, Mitterberger M, Hruby S, Kunit T, Kloss B, Engelhardt PF, Sieberer M, Janetschek G (2015) Update on the use of diode laser in the management of benign prostate obstruction in 2014. World J Urol 33(4):555–562. https://doi.org/10.1007/s00345-014-1327-0

    Article  PubMed  Google Scholar 

  25. Herrmann TR, Liatsikos EN, Nagele U, Traxer O, Merseburger AS, Eau Guidelines Panel on Lasers T (2012) EAU guidelines on laser technologies. Eur Urol 61(4):783–795. https://doi.org/10.1016/j.eururo.2012.01.010

    Article  PubMed  Google Scholar 

  26. Lusuardi L, Hruby S, Janetschek G, Mitterberger M, Sieberer M, Colleselli D, Kunit T, Hitzl W, Kloss B (2015) Laparoscopic adenomectomy versus eraser laser enucleation of the prostate. World J Urol 33(5):691–696. https://doi.org/10.1007/s00345-014-1476-1

    Article  PubMed  CAS  Google Scholar 

  27. Wu G, Hong Z, Li C, Bian C, Huang S, Wu D (2016) A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia: a randomized clinical trial with 12-month follow-up. Lasers Med Sci 31(4):599–604. https://doi.org/10.1007/s10103-016-1883-1

    Article  PubMed  Google Scholar 

  28. Fayad AS, Elsheikh MG, Zakaria T, Elfottoh HA, Alsergany R, Elshenoufy A, Elghamarawy H (2015) Holmium laser enucleation of the prostate versus bipolar resection of the prostate: a prospective randomized study. “Pros and Cons”. Urology 86(5):1037–1041. https://doi.org/10.1016/j.urology.2015.08.004

    Article  PubMed  Google Scholar 

  29. Elmansy HM, Kotb A, Elhilali MM (2011) Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate? J Urol 186(5):1977–1981. https://doi.org/10.1016/j.juro.2011.06.063

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank all the patients and surgeons, attending colleagues, study nurses in this study, thanks to the Clinical Research Associate and independent clinical events committee member of this trial.

Funding

Funded by Guangzhou Science Technology Key Program (201504301009390).

Author information

Author notes

  1. Zhihui Zou and Abai Xu have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China

    Zhihui Zou, Abai Xu, Shaobo Zheng, Binshen Chen, Yawen Xu, Hulin Li, Jiasheng Chen, Chaoming Li, Yiming Wang, Yubo Gao & Chunxiao Liu

  2. Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China

    Chongyang Duan

  3. State Key Laboratory of Organ Failure Research, National Clinical Research Centre for Kidney Disease, Guangzhou, Guangdong, China

    Chongyang Duan

  4. Department of Urology, The Second Affiliate Hospital of Shantou University Medical College, Shantou, Guangdong, China

    Junhong Zheng

  5. Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

    Zhihui Zou & Chaozhao Liang

  6. Department of Urology, Ludwig-Maximilians University, Munich, Germany

    Yiming Wang

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  1. Zhihui Zou
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Contributions

CL: project development, data management and analysis, and manuscript editing. ZZ: project development, data analysis, manuscript writing, medical illustration design, and video edit. AX: manuscript editing and data analysis. CD: data analysis. CL and JC: data collection. CL, JZ, YX, JC, HL, YW, YG, and CL provide technical or intellectual support.

Corresponding author

Correspondence to Chunxiao Liu.

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The authors have nothing to disclose.

Informed consent

Written informed consent was obtained from all subjects.

Ethical approval

Ethical approval has been taken from Institutional Ethical Committee.

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Supplementary material 1 Video modified DiLEP (WMV 45398 kb)

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Zou, Z., Xu, A., Zheng, S. et al. Dual-centre randomized-controlled trial comparing transurethral endoscopic enucleation of the prostate using diode laser vs. bipolar plasmakinetic for the treatment of LUTS secondary of benign prostate obstruction: 1-year follow-up results. World J Urol 36, 1117–1126 (2018). https://doi.org/10.1007/s00345-018-2229-3

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