Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients

doi:10.1016/j.ajur.2018.05.004

Asian Journal of Urology, 2019, 6 (3): 270-274 doi: 10.1016/j.ajur.2018.05.004

Original Articles

Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients

Luca Carmignani^a,Maria Chiara Clementi^a,Claudia Signorini^a,Gloria Motta^a,Sebastiano Nazzani^a,*(

),Franco Palmisano^b,Elisa De Lorenzis^b,Michele Catellani^c,Alessandro Francesco Mistretta^c,Andrea Conti^c,Valeria Tringali^c,Maria Beatrice Costa^d,Damiano Vizziello^a

^aPoliclinico San Donato, Urology, San Donato, Milanese, Italy
^bOspedale Maggiore Policlinico, Urology, Milan, Italy
^cIstituto Europeo di Oncologia, Urology, Milan, Italy
^dOspedale San Giuseppe, Urology, Milan, Italy

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Abstract

Objective: We aimed to determine safety and feasibility of thulium laser transurethral vapoenucleation of prostate (ThuVEP) for treatment of obese patients affected by benign prostatic hyperplasia (BPH). Methods: We retrospectively analysed data of 452 patients with BPH who underwent ThuVEP from February 2012 to March 2016 in a single center. Patients were divided into three groups according to body mass index (BMI, kg/m ²): Normal weight (18.5 ≤ BMI＜25; Group A), overweight (25 ≤ BMI＜30; Group B) and obese (BMI≥30; Group C), for a total of 412 patients evaluable for this study. Preoperative total serum prostate-specific antigen (PSA), digital rectal examination of the prostate, transrectal ultrasound (TRUS), renal ultrasound, urine culture, uroflowmetry, International Prostate Symptoms Score (IPSS), and Quality of Life (QoL) score were analyzed. Post-operative complications, hospital stay and days of catheterization, questionnaires and uroflowmetry at 1 and 3 months after surgery were evaluated. Preoperative data, surgical outcomes, complication rate and clinical outcomes were compared between groups. Results: The median age of patients was 69 years (Interquartile Range [IQR 10]). The preoperative median IPSS among groups was 19 (IQR 8.75), 20 (IQR 10), and 18 (IQR 10) respectively. At 1 and 3 months of follow-up, this value was 8 (IQR 7), 8 (IQR 4), 7 (IQR 5) and 5 (IQR 6.25), 5 (IQR 6), 6 (IQR 5), respectively (all p between groups＞0.05). There was no statistically significant difference among three groups as for hospital stay and days of catheterization (p ＞ 0.05). Conclusion: Our results showed that ThuVEP was safe and feasible even in overweight patients with substantially enlarged prostate.

Key words： Laser Thulium Prostate Overweight

Received: 03 March 2017 Available online: 17 May 2018

Corresponding Authors: Sebastiano Nazzani E-mail: sebastiano.nazzani@yahoo.com

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	Luca Carmignani
	Maria Chiara Clementi
	Claudia Signorini
	Gloria Motta
	Sebastiano Nazzani
	Franco Palmisano
	Elisa De Lorenzis
	Michele Catellani
	Alessandro Francesco Mistretta
	Andrea Conti
	Valeria Tringali
	Maria Beatrice Costa
	Damiano Vizziello

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Cite this article:

Luca Carmignani,Maria Chiara Clementi,Claudia Signorini, et al. Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients[J]. Asian Journal of Urology, 2019, 6(3): 270-274.

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http://www.ajurology.com/EN/10.1016/j.ajur.2018.05.004 OR http://www.ajurology.com/EN/Y2019/V6/I3/270

Parameters	Group A 18.5 kg/m²≤ BMI < 25 kg/m² n = 177	Group B + C BMI ≥ 25 kg/m² n = 235	Group C BMI ≥ 30 kg/m² n = 54	p-Value A vs. B	p-Value A vs. C
Age, year; mean (SD)/median (IQR)	70 (11)	69 (10)	68 (8.5)	0.853	0.804
PSA, ng/mL; mean (SD)/median (IQR)	2.50 (2.96)	2.91 (3.7)	3.34 (3)	0.241	0.163
Prostate volume, mL; mean (SD)/median (IQR)	60 (47.65)	75 (52)	78.5 (45)	<0.001	0.003
Indwelling catheter, n (%)
Yes	47 (25.4)	51 (21.7)	8 (14.8)
No	130 (74.6)	184 (78.3)	46 (85.2)	0.232	0.077
Diabetes, n (%)
Yes	17 (9.6)	33 (14.0)	10 (19)
No	125 (70.6)	148 (63)	34 (62)
Unknown	35 (19.8)	54 (23)	10 (19)	0.157	0.078
Alpha blocker, n (%)
Yes	116 (65.5)	167 (71)	39 (72.2)
No	61 (34.5)	68 (29)	15 (27.8)	0.253	0.361
Antiplatelet or anticoagulant medications, n (%)
Acetylsalicylic acid	37 (21)	60 (25.5)	15 (27.8)	0.310	0.290
Other antiplatelet drugs	9 (5.0)	8 (3.4)	1 (1.8)	0.537	0.307
Anticoagulant drugs	13 (7.4)	14 (6)	4 (7.4)	0.905	0.988
No	118 (66.6)	153 (65.1)	34 (63.0)	0.163	0.051
ASA score, n (%)
1	31 (17.5)	38 (16.1)	6 (11.1)	0.837	0.261
2	110 (62.7)	154 (65.6)	35 (64.8)	0.495	0.597
3	36 (19.8)	43 (18.3)	13 (24.1)	0.280	0.495
4	0	0	0	0	1
IPSS preop, median (IQR)	19 (8.75)	20 (10)	18 (10)	0.236	0.603
QoL score preop, median (IQR)	4 (2)	4 (2)	4 (2)	0.206	0.681
Q_max, mL/s preop; median (IQR)	8.4 (4.6)	8.0 (3.9)	8.5 (3.6)	0.702	0.913
PVR, mL preop; median (IQR)	122 (145)	120 (152.5)	109 (160)	0.743	0.968
Operative time (min); median (IQR)	70 (40)	75 (40)	85 (50)	0.096	0.066
Hb decrease (g/dL); median (IQR)	1 (1.28)	1 (1.2)	0.8 (1.15)	0.600	0.031
Bladder irrigation time (h); median (IQR)	20 (6)	20 (6)	20 (6)	0.684	0.758
Catheterization time (h); median (IQR)	34 (20)	28 (22)	28 (19.5)	0.710	0.951
Hospital stay (day); median (IQR)	2 (1)	2 (1)	2 (1)	0.902	0.732
1 month IPSS, median (IQR)	8 (7)	8 (4)	7 (5)	0.356	0.161
1 month QoL score, median (IQR)	2 (2)	2 (2)	1 (2)	0.170	0.028
1 month Q_max, mL/s; median (IQR)	16.6 (9.35)	16.1 (10.3)	18 (11.78)	0.880	0.262
1 month PVR (mL); median (IQR)	30 (39)	40 (86)	25 (83.5)	0.030	0.570
3 month IPSS, median (IQR)	5 (6.25)	5 (6)	6 (5)	0.765	0.475
3 month QoL score, median (IQR)	1 (2)	1 (2)	1 (2)	0.839	0.830
3 month Q_max, mL/s; median (IQR)	21 (9.48)	20 (9.78)	21.35 (10.8)	0.727	0.380
3 month PVR, mL; median (IQR)	15 (28.5)	0 (51)	15 (76)	0.869	0.380
AUR with recatheterization (Clavien II), n	18	29	7	0.709	0.650
Delayed morcellation (Clavien IIIa), n	1	1	0	0.840	0.580
Transfusion rate, n	4	1	0	0.169	0.575
UTI (Clavien II), n	0	2	1	0.131	0.070
MI/stroke (Clavien IV), n	1	1	0	0.840	0.580
Bladder injury (Clavien I), n	1	0	0	0.249	0.580

Patients characteristics, preoperative functional characteristics, perioperative data, 1 and 3 months follow-up functional data, and postoperative complications.

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