Thulium laser transurethral incision of the prostate with ejaculation-sparing intent: 2-year follow-up outcomes from a high-volume centre

Abstract

Introduction:

Several 'ultra-minimally-invasive' surgical treatments (uMISTs) have been developed, aiming to relieve benign prostatic obstruction (BPO) and spare ejaculatory function; however, such techniques do not always ensure substantial improvements in uroflowmetry parameters. The aim of the present study was to evaluate the 2-year functional outcomes of thulium laser transurethral incision of the prostate (ThuIP) as an alternative to uMISTs.

Material and methods:

Data of consecutive patients affected by BPO with indication to surgical intervention and a strong will to spare ejaculatory function were collected on a dedicated prospectively maintained database. A specific "trifecta" was identified as the contemporary presence of: (1) post-operative Qmax ≥15 ml/s; (2) absence of early (within 90 days) complications; and (3) preserved antegrade ejaculation.

Results:

120 patients underwent ThuIP and were analysed. Median catheterisation time was 2 days (IQR 2-2). Significant improvements in IPSS and IPSS-QoL scores and uroflowmetry parameters were observed at all follow-up times. At the last follow-up visit (24 months) the median ΔIPSS was -12 (-17; -9), median ΔIPSS-QoL was -3 (-4; -2), median ΔQmax was +7.7 ml/s (+5.2; +11.0), and median ΔPVR was -50 ml (-100; 0) (all p-values <0.001). Fourteen patients reported postoperative absence of antegrade ejaculation (11.7%). Overall, trifecta was achieved in 86 patients (71.7%) at 6 months, in 79 patients (65.8%) at 12 months, and in 75 patients (62.5%) at 24 months.

Conclusions:

ThuIP allows for a significant improvement in uroflowmetry parameters and patient-reported outcomes at 2-year follow-up. Moreover, antegrade ejaculation is preserved in approximately 90% of cases.

Carilli M, Bertolo R, Vittori M, Iacovelli V, Antonucci M, Maiorino F, Signoretti M, Petta F, Bove P. Thulium laser transurethral incision of the prostate with ejaculation-sparing intent: 2-year follow-up outcomes from a high-volume centre. Cent European J Urol. 2024;77(2):235-242. doi: 10.5173/ceju.2023.266. Epub 2024 Apr 7. PMID: 39345328; PMCID: PMC11428362.