Top-down Thulium Fiber Laser (TFL) enucleation of the prostate: Early postoperative outcomes
Hazem Elmansy1, Waleed Shabana1, Miranda Waugh1, Abdulrahman Ahmad1, Ruba Abdul Hadi1, Thomas Tablowski1, Ahmed Kotb1, Walid Shahrour1.
1Northen Ontario School Of Medicine, Thunder Bay, ON, Canada
Introduction: Thulium fiber laser (TFL) enucleation of the prostate is an emerging technology for endoscopic prostate enucleation that is notable for its high wavelength and pulsed mode of action. We demonstrate the operative parameters and postoperative outcomes of top-down TFL enucleation of the prostate.
Methods: Between July 2020 and August 2020, 10 patients with a median age of 79 years (66-83) underwent TFL enucleation of the prostate using the top-down approach. The procedures were performed by a single surgeon (HE) using a 28F continuous flow resectoscope (Karl Storz, GmbH, Tuttlingen, Germany) and a 550 µm Thulium fiber laser (Soltive™ SuperPulsed Laser System, Olympus). Operative parameters, including enucleation time, morcellation time, and perioperative complications, were recorded and statistically analyzed. Early postoperative outcome data were collected after 3 months and compared to preoperative parameters.
Results: The median preoperative prostate size was 97 grams (85-117) and the median preoperative PSA was 3.1ng/dl (2.7-3.6). No intraoperative or early postoperative complications were recorded. At 3 months postoperative, there were significant improvements in postoperative urinary functions including Qmax (7.4(4.9-9.9) vs 19.2(17.1-26.3, p<0.01) mL/sec, PVRV (137.9(128.3-141.8 vs 14.5(11.6-17.9, p<0.01) mL, IPSS score (20.8(18.5-22.7) vs 6.9(5.7-8.1), p<0.001) and QoL score (4.1(3.7-4.8) vs 1.5(1.1-1.8), p<0.001).
Conclusions: The top-down enucleation technique is safe and effective with the novel TFL. The preliminary results demonstrate a significant improvement in urinary outcomes.
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