von Bargen M F, Glienke M, Tonyali S, Sigle A, Wilhelm K, Schoenthaler M, Gratzke C, Miernik A
Faculty of Medicine, Department of Urology, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany.
Department of Urology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
World J Urol. 2025 Jul 26;43(1):459. doi: 10.1007/s00345-025-05756-5.
Due to its physical properties, endoscopic enucleation of the prostate (EEP) with the pulsed solid-state Thulium: YAG laser (pulsed ThuLEP) presents a promising alternative to the widely used Holmium: YAG laser (HoLEP). This study aims to compare perioperative parameters of EEP performed using a novel 100 W pulsed Thulium: YAG laser with high peak power versus a standard 100 W Holmium: YAG laser in patients with benign prostatic hyperplasia (BPH).
A retrospective analysis was conducted on 312 patients undergoing laser EEP, comprising 80 pulsed ThuLEP and 232 HoLEP procedures. Outcomes were adjusted for key perioperative variables (age, American Society of Anesthesiologists score, hemoglobin, preoperative prostate volume, prostate-specific antigen levels) through multivariable regression analysis. Comparisons between the two techniques utilized adjusted means and marginal contrast analysis.
Baseline characteristics were comparable across groups. Pulsed ThuLEP demonstrated significantly shorter operative times, with a reduction of 6.23 min in total surgery time (p = 0.006) and 4.36 min in enucleation time (p = 0.001) compared to HoLEP. Although pulsed ThuLEP showed faster enucleation speed, it did not reach statistical significance (p = 0.095). Laser energy consumption was comparable (p = 0.191). Additionally, pulsed ThuLEP was associated with reduced hospitalization time (4.19 vs. 4.65 days, p < 0.001) and lower maximum postoperative pain scores (0.78 vs. 4.23, p < 0.001).
The novel pulsed solid-state Thulium: YAG laser offers a viable and effective alternative to the established Holmium: YAG laser for EEP. Advantages of pulsed ThuLEP include shorter operative duration, reduced length of hospital stay, and significantly lower postoperative pain, making it a compelling option for surgical management of BPH.
German Clinical Trials Register number: DRKS00031676.
由于其物理特性，采用脉冲固态铥激光（pulsed ThuLEP）进行前列腺内镜剜除术（EEP）是广泛使用的钬激光（HoLEP）的一种有前景的替代方法。本研究旨在比较使用新型100W高峰值功率脉冲铥激光与标准100W钬激光对良性前列腺增生（BPH）患者进行EEP的围手术期参数。
对312例行激光EEP的患者进行回顾性分析，包括80例脉冲ThuLEP手术和232例HoLEP手术。通过多变量回归分析对围手术期关键变量（年龄、美国麻醉医师协会评分、血红蛋白、术前前列腺体积、前列腺特异性抗原水平）进行结果调整。两种技术之间的比较采用调整均值和边际对比分析。
各组基线特征具有可比性。与HoLEP相比，脉冲ThuLEP的手术时间明显更短，总手术时间减少6.23分钟（p = 0.006），剜除时间减少4.36分钟（p = 0.001）。虽然脉冲ThuLEP显示出更快的剜除速度，但未达到统计学意义（p = 0.095）。激光能量消耗相当（p = 0.191）。此外，脉冲ThuLEP与住院时间缩短（4.19天对4.65天，p < 0.001）和术后最大疼痛评分降低（0.78对4.23，p < 0.001）相关。
新型脉冲固态铥激光为EEP提供了一种可行且有效的替代钬激光的方法。脉冲ThuLEP的优点包括手术时间缩短、住院时间缩短和术后疼痛明显减轻，使其成为BPH手术治疗的一个有吸引力的选择。
德国临床试验注册编号：DRKS00031676。
