Thulium vapoenucleation well-tolerated for treating benign prostate obstruction

Dec 10 2012

By Stephanie Leveene, medwireNews Reporter

Treating benign prostate obstruction (BPO) with thulium vapoenucleation of the prostate (ThuVEP) is well-tolerated and effective and leads to a low incidence of perioperative complications, according to recent study findings.

Although the perioperative morbidity of ThuVEP has been assessed in earlier studies, this was the first to look at complication rates using the standard modified Clavien classification system and to analyze the immediate outcomes of ThuVEP.

Christopher Netsch (Asklepios Hospital Barmbek, Hamburg, Germany) and colleagues note that, as only short-term data were reported in their study, "prospective, multi-center studies may be more appropriate to assess the surgical outcome and complication rates of minimally invasive procedures for BPO."

The current gold standards for BPO, transurethral resection of the prostate (TURP) and open

prostatectomy, are associated with considerable perioperative morbidity issues, including severe bleeding and prolonged recovery.

The ThuVEP procedure was developed as a minimally invasive, size-independent treatment approach similar to holmium laser enucleation.

Netsch and colleagues studied perioperative complication rates in a prospective analysis of 1080 patients undergoing ThuVEP for BPO. Early postoperative outcomes were also assessed.

At discharge, maximum urinary flow rate had increased from a median of 8.9 mL/sec to 18.4 mL/sec. The morbidity rate was just under 17%; the most frequent complications were acute urinary retention, surgical revision, and significant urinary tract infection. The rate of complications was similar to that seen with most other BPO treatment procedures and significantly better than that for TURP in patients with small or midsized prostates.

Minor complications occurred in 24.6% of patients (Clavien 1: 20.8%; Clavien 2: 3.8%), and major complications requiring reinterventions within 4 weeks occurred in 6.6% of patients (Clavien 3a: 0.6%; Clavien 3b: 6.0%). The overall rate of complications decreased significantly over time.

Netsch and colleagues note in European Urology that the limitations of the study include its prospective and unicentric design and a lack of control group or comparison group of patients who had undergone a TURP procedure.

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