Early Experience of Thulium Laser Vaporization of the Prostate

1. No. 092 Early Experience of Thulium Laser Vaporization of the Prostate Dr. Tony Gianduzzo Sunshine Coast Private Hospital, Buderim, Qld. Introduction Laser procedures are now considered an alternative to TURP, with goals of at least equal efficacy, lower morbidity, and shorter hospital stay. Thulium lasers use an invisible (near infra-red), continuous wave to rapidly vaporise tissue by a photothermaleffect with no deep necrosis. They offer unsurpassed versatility, providing the surgeon with a choice of vaporisation, resection or enulcleationtechniques, as well as effective bladder stone lithotripsy. Thulium lasers uniquely offer the combination of effective tissue vaporisation with safety features of excellent intraoperative vision (no flare) and water absorption, avoiding overshoot concerns by only affecting tissue within several millimetres of the laser fibre tip. 1,2,3 Results - 48 patients • Indications • 28 lower urinary tract symptoms • 13 acute urinary retention with catheter/ failed trial of void • 5 chronic retention/ upper tract dilation • 2 bladder stone Aims Assess the safety and efficacy of thulium vaporisation of the prostate (ThuVAP) using the 180Watt CyberTM generator in the treatment of bladder outlet obstruction due to benign prostatic hyperplasia. Develop a safe, easy to learn, Medicare-compliant, side-fire non-contact operative technique. Good relief of lower urinary tract symptoms Methods With ethics committee approval, ThuVAP was performed on 48 consecutive patients who would otherwise be considered suitable for TURP in a community urological practice from May 2011 to March 2012 . Clopidogrelor coumadin were ceased. Patients with catheter dependent retention or obstructive uropathy were included. There was no limitation on prostatic volume (largest 240 cc). Prostatic volume was measured by transrectal ultrasound. Laser energy was delivered by a CyberTM 180 Watt thulium device. Side-fire vaporisation of the prostate was performed using a single-use 600µm fibre, switching to a reusable 800µm end-fire fibre in large glands as required. Prostatic volumes >80cc were treated early in the series. Initial attempts to replicate a photo-vaporization of the prostate (PVP) like technique with manual handling of the laser fibre via a cystoscope were quickly abandoned for a more efficient and surgically familiar approach using a Wolf 24.5 Fr. resectoscope and working element, similar to TURP. This also improved irrigation flow, mitigating visibility issues from contact mucosal bleeding in large glands. Catheters were typically removed on the day of surgery, and patients generally discharged on the first postoperative day. Patients were instructed to avoid strenuous activity for 2 weeks, reviewed at 2-4 weeks, and discharged from follow-up after satisfactory resolution of retention and urinary symptoms. All patients initially in retention are catheter free (0-5 weeks) • Complications • 1 Clot retention - 3 weeks post op • 1 revision of apical tissue at 6 months (early case) • 3 UTI’s • No transfusions • No bladder/ ureteric injury • No stress incontinence • No significant dysuria 24.5 Fr. laser resectoscope/ working element Prostates >160 cc – 5 patients - 4 AUR, 1 stone Operative times in large prostates are comparable to open prostatectomy These 5 patients discharged catheter free day 1, with average residual urine 32 cc, discharge from care at av. of 3 weeks post-op, with av. IPSS/ QoL scores 6.3/ 0.0 Conclusions Thulium laser vaporisation of the prostate is a safe and effective technique, even when including patients with catheter dependent retention, obstructive uropathy, or with prostatic volumes up to 240 cc. The learning curve for ThuVAP was minimal when performed with a resectoscope working element, creating a TURP-like cavity to capsule. Ongoing study is underway to confirm recent reports of the safe use of thulium laser prostatectomy in patients taking clopidogrel or coumadin.3 References Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN. Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol. 2008;53:382-389. Mattioli S, Munoz R, Recasens R et al. [Treatment of benign prostatic hyperplasia with the Revolix laser]. Arch Esp Urol. 2008;61:1037-1043. Herrmann TR, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. EAU Guidelines on Laser Technologies. Article in press. Eur Urol. 2012 Acknowledgements UnitingCare Health Human Research Ethics Committee. Equipment owned by Sunshine Coast Private Hospital. There are no conflicts of interest to declare. Poster presentation sponsor