Thulium Laser Prostate Enucleation in Refractory Urinary Retention: Operative and Functional Outcomes in a Large Cohort of Patients

OBJECTIVE - To evaluate the functional and operative results of thulium laser prostate enucleation (ThuLEP) in patients with indwelling catheters for refractory urinary retention (RUR).

METHODS - Patients with indwelling catheter, undergoing ThuLEP for benign prostate hyperplasia were prospectively enrolled.

Every episode of urinary retention was treated with urinary catheter positioning followed by at least two attempts of catheter removal. Patients were investigated with flowmetry and the self-administered International Prostate Symptom Score (IPSS) questionnaire at 30 and 90 days following ThuLEP.

RESULTS - Three hundred eighty one patients underwent ThuLEP, 99 of these had indwelling catheters, but only 93 (24%) were eligible according to the inclusion criteria. In 46 patients the bladder catheter was removed on the first post-operative day, in 31 patients on the second post-operative day, in 5 patients on the third, in 6 patients on the fourth, in 1 patient on the fifth, and in 2 patients each on the sixth and seventh day. The average hospital stay was 2.3 (± 1.7) days. No patients undergoing ThuLEP, at the 90-day follow-up, required further catheterization. Flowmetry showed significant improvement in all parameters, and the mean IPSS score dropped from 21.33 pre-operatively to 3.2 (p = 0.004) at 90 days post-operatively.

CONCLUSIONS - This prospective study shows that ThuLEP is a safe and effective approach in RUR patients. In our case series no patients required post-operative intermittent catheterization. All functional outcomes investigated reported a statistical significant improvement.

Urology. 2016 Mar 23 [Epub ahead of print]

Luca Carmignani, Antonio Luigi Pastore, Stefano Carlo Maria Picozzi, Elisabetta Finkelberg, Dario Ratti, Damiano Vizziello, Maria Lucia Schirinzi, Antonino Saccà, Francesca Pisano, Serena Maruccia

Department of Urology, IRCCS Policlinico San Donato, Milano, Italy., Urology Division, Department of Medico Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Latina, Italy., Department of Urology, IRCCS Policlinico San Donato, Milano, Italy., Department of Urology, IRCCS Policlinico San Donato, Milano, Italy., Department of Urology, IRCCS Policlinico San Donato, Milano, Italy., Department of Urology, IRCCS Policlinico San Donato, Milano, Italy., Department of Urology, IRCCS Policlinico San Donato, Milano, Italy., Department of Urology, AO Papa Giovanni XXIII, Bergamo, Italy., Department of Urology, AO Città della Salute e della Scienza, University of Turin, Italy., Department of Urology, IRCCS Policlinico San Donato, Milano, Italy. 

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