الفهرس 
Benign Prostatic Hyperplasia (BPHOnly 14 pages are availabe for public view
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Abstract
This study was performed to compare the safety and efficacy of 30watt ThuLEP with
60watt ThuLEP in the management of BPH.
All Patients were preoperatively evaluated in detail by medical history, physical
examination including DRE, laboratory investigations including preoperative serum
sodium level, and imaging evaluation including abdomino-pelvic and trans rectal
ultrasound. IPSS was determined in all cases. Patients were further assessed by
uroflowmetry (Q max). Assessment of IPSS, Qmax, and PVR urine volume were
omitted in men presented by urinary retention.
In both groups; resection time and resected volume were analyzed. Blood loss and
DROP in Hemoglobin and sodium values were determined. Postoperative catheter time
and hospital stay were recorded. Intraoperative and postoperative complications and the
need for blood transfusion were noted. The improvements of IPSS, Q max, and PVR
urine after three months were also recorded for all patients.
In our study we found that the utilization of such low power revealed a
significantly longer operative (about 15 minutes longer surgery) in comparison with the
60-Watt group.
The low power setting (30 Watts) in our practice may be beneficial for beginner
surgeons, providing a less brown eschar that may obscure the enucleation plane. That
would make the enucleation progress easier for those starting the ThuLEP curve. And in
the same time it provides the same setting for both coagulation and cutting, which
doesn’t need to be changed if the surgeon doesn’t have the double-pedaled laser foot
switch
The incidence of intraoperative capsular perforations (p=0.7) or need for blood
transfusion (p=0.3) was not affected by the different utilized power in both groups. The
same incidence of capsular perforation is explained by the interrupted laser release of
Summary and Conclusion
58
fibrous attachments between the capsule and adenoma, by either 30- or 60-Watt power
won’t lead to perforations; that happens usually due to loss of 3D orientation.
The postoperative stress incontinence in the 1st 3 months was 5 % in the 30 Watt
group versus 7% in the 60 Watt group (p=0.2). So, using the relatively higher power (60
Watt ThuLEP) when dealing with the mucosal strip didn’t show a significant difference
in the postoperative continence and this may be related to the direction of the fiber,
limited thulium Yag penetration depth( =0.2) and the distance that we leave from the
mucosal strip away from the sphincter.
The theoretical concerns regarding the laser power and erectile dysfunction were not
proved in our study since our results should no difference (p=0.1) between 30 and 60-
watt thulium over the change of IIEF-5 score at 12-month follow-up compared to
baseline.
All patients in both groups showed marked improvement in IPSS, Qmax, and PVR
after 12 months postoperative with suspected more improvement in both groups with
time, but the differences between groups were insignificant.
Conclusion
The 60-Watt ThuLEP proved to have a shorter operative time while providing
the same postoperative outcomes as the 30-Watt one. Perhaps using a 30-Watt setting
would be beneficial in the early learning curve or cases with more bleeding capsular
perforators; besides the financial benefit of manufacturing low-cost low power devices
that may help in the widespread of AEEP.
Recommendations
When you are a beginner and you want to efficiently enaculate the prostatic adenoma
endoscopically using thulium laser, You should start first using low power, This will
give you the chance to have abetter field and you can shift to Bipolar or high power if it
is difficult to obtain prober hemostasis at the enaculation plane.