Laser enucleation fo the prostate: A comparison of Thulium and Holmium laser energy sources

1. No. 048 Laser enucleationfo the prostate: A comparison of Thulium and Holmium laser energy sources R. Thanigasalam, W. Massoud, A. El Hajj, P-E. Theveniaud, F.Girard, M. Fennouri, O.Dumonceau, H. Baumert Department of Urology, GroupeHospitalier Paris Saint-Joseph, Paris 75014, France Posters Proudly Supported by: • Results • Thulium was noted to be more efficient with respect to haemostasis when compared with Holmium. • The development and maintenance of the enucleation plane was noted to be more effective with the Holmium when compared with the Thulium laser. • In both patients the size of the prostatic adenoma was ~90grams. • Apical dissection of the left lateral lobe with Thulium laser on the left image • and Holmium laser on the right • The foley catheter was removed and both patients were discharged on post-operative day 1. • The patient that had the Holmium laser enucleation had a pre-operative IPSS of 9 and a post-operative IPSS of 17, and a pre-operative urinary flow rate of 12mls/sec and post-operative flow rate of 28mls/sec. • The patient that had the Thulium laser enucleation had a pre-operative IPSS of 11 and a post-operative IPSS of 18, and a pre-operative urinary flow rate of 10mls/sec and post-operative flow rate of 25mls/sec. • Neither patient had post operative complications. Introduction The use of a laser as an alternative to a classic TURP to treat BPH is an evolving and popular technique for the urologist. In larger prostates (>80grams), transurethral laser enucleation of the gland is an excellent alternative to other classical surgical options with a low morbidity rate, low complication rate and comparable functional results.1,2 Aim We present our technique (in this video) of laser enucleation of the prostate comparing the Thulium and Holmium laser energy sources. • Methods • The Thulium laser (Revolix* - LISA) works in a continuous mode on a wavelength of 2µm, with an output power of 70 Watts. • The Holmium laser (Versapulse* - Lumenis) works in a pulsating mode on a wavelength of 2.1 µm, with an output power of 100 Watts. • For each laser enucleation procedure we used a 26 Fr laser specific resectoscope adapted for a reusable laser fiber, with normal saline irrigation. • The same enucleation technique was performed in both lobes of the prostate. • We began by scoring 3 indicators lines at the 5, 7 and 12 o’ clock positions with the laser. In each lateral lobe, the enucleation begins at the apex and is continued in a retrograde fashion towards the bladder neck. • Following enucleation of both lobes, the two adenomas were evacuated using an endoscopic morcellator. • A simple foley catheter was placed after successful evacuation of all prostatic tissue. Conclusions Holmium and Thulium laser energy sources represents a safe and effective treatment option in patients with large symptomatic adenomas. References 1Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU international 2012;109(3):408-1. Gilling P et al 2 Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol. 2010 Feb;28(1):45-51. Herrmann TR et al Acknowledgements