Comparison of Outcome and Quality of Life Between Thulium Laser (Vela^TM XL) Enucleation of Prostate and Bipolar Transurethral Enucleation of the Prostate (B-TUEP)

Figures & data

Table 1 Baseline Characteristics-1

	Bipolar TUEP (n=49)		ThuLEP (n=62)		p value
	Mean	SD	Mean	SD
Age (year)	65.7	8.4	68.6	8.6	0.071
PSA (ng/mL)	6.5	7.5	4.6	3.8	0.112
Cre (mg/dL)	1.0	0.3	1.0	0.3	0.301
Prostate volume (mL)	51.3	20.9	49.9	16.1	0.696
T-zone (mL)	23.9	12.9	22.9	11.3	0.650
Comorbidities	n	%	n	%	p value
T2DM	15	30.6%	10	16.1%	0.070
Hypertension	31	63.3%	23	37.1%	0.006
CAD	5	10.2%	1	1.6%	0.086
CHF	2	4.1%	1	1.6%	0.582
Arrythmia	6	12.2%	4	6.5%	0.332
Stroke	8	16.3%	4	6.5%	0.096
Spinal cord injury	0		0
Chronic renal insufficiency	3	6.1%	2	3.2%	0.653
Urologic cancer	0		0
Other cancer	2	4.1%	5	8.1%	0.480
Anti-coagulants use	12	24.5%	12	19.4%	0.514
Ever endoscopic stone Tx	5	10.2%	3	4.8%	0.299

Abbreviations: B-TUEP, bipolar transurethral enucleation of the prostate; ThuLEP, thulium laser enucleation of the prostate; SD, standard deviation; PSA, prostatic specific antigen; Cre, creatinine; T-zone, transitional zone of prostate; T2DM, type 2 diabetes mellitus; CAD, coronary artery disease; CHF, chronic heart failure; Tx, treatment.

Table 2 Baseline Characteristics-2

	Bipolar TUEP (n=49)			ThuLEP (n=62)			p value
	Median	Q1	Q3	Median	Q1	Q3
IPSS (total)	25	23	28	25	21	28	0.593
IPSS (voiding)	15	13	18	15	14	19	0.611
IPSS (storage)	10	8	12	9	7	13	0.325
IPSS (QoL)	5	4	5	5	4	5	0.946
	Mean	SD		Mean	SD
Qmax (mL/sec)	7.2	3.6		9.2	4.1		0.013
VV (mL)	160.0	79.9		217.2	110.6		0.003
PVR (mL)	164.8	224.7		89.5	117.2		0.041

Abbreviations: B-TUEP, bipolar transurethral enucleation of the prostate; ThuLEP, thulium laser enucleation of the prostate; IPSS, international prostate symptom score; QoL, quality of life; Qmax, peak urinary flow; VV, voiding volume; PVR, postvoid residual volume.

Table 3 Perioperative Results

	Bipolar TUEP (n=49)		ThuLEP (n=62)		p value
	Mean	SD	Mean	SD
OP time (min)	77.7	30.1	84.5	29.9	0.241
Blood loss (mL)	199.2	219.2	82.4	99.4	< 0.001
Percentage of tissue resected (%)	70.4%	23.9%	70.7%	25.1%	0.957
Hospitalization duration (day)	2.5	1.2	2.1	0.4	0.118
Post OP Pain score = 0	n	%	n	%
Post-op day 1	16	32.7%	45	72.6%	< 0.001
Post-op day 2	25	51.0%	50	80.6%	0.001
	n	%	n	%
Manual irrigation	2	3.7%	0	0	0.193
TUR check bleeding	1	2%	0	0	0.441
Blood transfusion	0		0
Re-catheterization	3	6.1%	5	8.1%	1.000
Additional narcotic use	4	8.2%	4	6.5%	0.730
Post OP UTI	15	31.3%	14	22.6%	0.306
Analgesics requirement over one week	9	18.8%	5	8.1%	0.095
Returned to ER within one month	11	22.4%	5	8.1%	0.032
UR	2		1
Hematuria	5		0
UTI	1		2
Bladder tamponade	1		0
Others	4		1
Urethral stricture	2	4.1%	6	9.7%	0.462

Abbreviations: B-TUEP, bipolar transurethral enucleation of the prostate; ThuLEP, thulium laser enucleation of the prostate; OP, operation; TUR, transurethral; NRS, numeric pain rating scale; UTI, urinary tract infection; ER, emergency room; UR, urinary retention; Q1, Quartile 1; Q3, Quartile 3.

Figure 1 Flowchart of patient treatment.

Table 4 Postoperative IPSS and QoL Changes

	Bipolar TUEP			ThuLEP			p value
Post-OP 2 Weeks	Median	Q1	Q3	Median	Q1	Q3
Δ IPSS	−18.5	−23.0	−15.5	−19.0	−23.0	−14.0	0.884
Δ IPSS (voiding)	−13.5	−17.0	−12.0	−15.0	−17.0	−11.0	0.226
Δ IPSS (storage)	−5.0	−8.0	−1.5	−4.0	−8.0	−1.0	0.137
Δ IPSS (QoL)	−3.0	−4.0	−2.0	−3.0	−4.0	−2.0	0.877
Post-OP 3 Months	Median	Q1	Q3	Median	Q1	Q3
Δ IPSS	−21.5	−23.8	−16.3	−20.0	−25.0	−16.0	0.824
Δ IPSS (voiding)	−14.0	−16.8	−12.0	−15.0	−17.0	−13.0	0.263
Δ IPSS (storage)	−7.0	−10.0	−4.3	−5.5	−9.0	−2.0	0.301
Δ IPSS (QoL)	−3.0	−4.0	−3.0	−3.0	−5.0	−2.0	0.507
Post-OP 6 Months	Median	Q1	Q3	Median	Q1	Q3
Δ IPSS	−21.5	−24.0	−19.3	−21.5	−25.5	−16.0	0.784
Δ IPSS (voiding)	−13.5	−17.0	−12.0	−14.5	−18.0	−10.0	0.831
Δ IPSS (storage)	−7.0	−9.0	−5.3	−6.5	−9.3	−4.0	0.737
Δ IPSS (QoL)	−3.0	−4.0	−2.0	−3.5	−4.0	−3.0	0.270

Abbreviations: B-TUEP, bipolar transurethral enucleation of the prostate; ThuLEP, Thulium laser enucleation of the prostate; ∆, change in a variable; IPSS, international prostate symptom score; QoL, quality of life; Q1, Quartile 1; Q3, Quartile 3.

Figure 2 Postoperative changes in uroflowmetry parameters at 2 weeks, 3 months, and 6 months. (A) Changes in peak flow rate. (B) Changes in voiding volume. (C) Changes in postvoid residual volume. *Indicates a statistically significant difference.

Figure 3 The Kaplan-Meier plot illustrating the two groups’ medication-free survival rates over time.