A Clinical Study On The Comparison Of The Curative Effect Of Thulium Laser Prostatectomy And Thulium Laser Prostatectomy On Small-volume Prostate

Part I Comparison of two methods of transurethral resection of small prostate: Thu LEP and Tm LRPObjective To compare the safety and efficacy of thulium laser enucleation of the prostate(Thu LEP)versus thulium laser resection of the prostate(Tm LRP)in small prostates(?30 g)and to test the validity of Thu LEP for bladder neck contracture(BNC).Methods A total of 115 patients with benign prostatic hyperplasia(BPH)(prostate size?30 g)were randomly assigned to Thu LEP(n=56)or Tm LRP(n=59).All patients were evaluated preoperatively and at 1,3,6,and 12 months after surgery.Baseline characteristics of the patients,perioperative data,postoperative outcomes and complications were assessed.Results Comparisons of the baseline and perioperative data demonstrated no significant differences between the Thu LEP and Tm LRP groups.Significant improvement was noted in the International Prostate Symptom Score(IPSS),quality of life(Qo L),maximal urinary flow rate(Qmax)and post-void residual volume(PVR)in both groups at the 12-month follow-up,and assessment showed no differences in these parameters between the two groups.The Tm LRP group showed a significantly higher rate(13.6%)of BNC than the Thu LEP group(1.8%;p=0.045).There were no significant differences in other complications between the two groups(P>0.05).Conclusions ThuLEP and TmLRP are both safe and efficient procedures for the treatment of patients with small prostate volume,while Thu LEP can significantly reduce the risk of BNC in patients with a small prostate because the procedure enucleates adenomas without thermal damage to the bladder neck.Part II Impact of Thu LEP on sexual function of patients with benign prostatic hyperplasiaObjective To evaluate the influence of thulium laser resection of the prostate(Tm LRP)on sexual function of patients with benign prostatic hyperplasia(BPH).Methods Patients with benign prostatic hyperplasia in Shanghai General Hospital from 2015 to 2016 were selected and treated with Thu LEP.IPSS,Qo L,PVR,Qmax were recorded to evaluated the outcome of the operation,the sexual functions were evaluated with IIEF-5 before and after the operation.The incidence of painful ejaculation and retrograde ejaculation(RE)were counted.Normally distributed continuous variables were compared by t-tests and Categorical data were compared by the ?2 test.P values less than 0.05 were considered statistical significance.Results IPSS,Qo L,Qmax,and PVR were significantly improved compared with preoperatively.The above indexes were statistically significant compared with the preoperative period(P<0.05).There was no statistically significant difference in erectile function before and after surgery(P>0.05),and no significant decrease in penile erectile function was found.The incidence of retrograde ejaculation and ejaculatory volume reduction at 6 and 12 months after operation were 68%,26% and 58%,23% respectively,there was a significant difference compared with preoperative(P<0.05);The incidence of painful ejaculation was 4% and 3%,and there was no significant difference compared with preoperative(P>0.05).Conclusions Tm LRP can significantly alleviate the symptoms of LUTS caused by BPH and significantly improve the quality of life of patients.There is no obvious damage to erectile function after surgery,and the erection can be normal and the sexual life can be maintained.The unique characteristic of thulium laser and the innovative technique can protect the sexual function.