Clinical study of thulium laser endoluminal anatomical prostate enucleation in ambulatory surgery mode
Zou Zhihui1,2,3, Hu Yongtao1,2,3, Zhang Ligang1,2,3, Cheng Jia1,2,3, Ge Qintao1,2,3, Lu Yao4, Zhang Jing5, Li Fang6, Song Zhen1,2,3, Hao Zongyao1,2,3, Liang Chaozhao1,2,3,*
1Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; 2Anhui Province Key Laboratory of Genitourinary Diseases, Hefei 230022, China; 3Anhui Clinical Research Center of Urinary System Diseases, Hefei 230022, China; 4Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; 5Day Operating Room, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; 6Day Surgery Ward, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
Abstract：Objective： To evaluate the feasibility and safety of thulium laser transurethral enucleation of the prostate （ThuLEP） in the treatment of benign prostatic hyperplasia （BPH） in a day surgery mode. Methods： Between October 2021 and March 2022, a total of 56 BPH patients received outpatient screening and underwent day-surgery of ThuLEP in the First Affiliated Hospital of Anhui Medical University. Patients completed all preoperative examinations during the pre-hospitalization period, and the operation was arranged on the day of admission. All operations were performed by Dr. Zou. The operation followed the standard of anatomic prostatic enucleation, and the adenoma was completely removed （shown as video and illustrations）. Drinking and eating started at the time of postoperative anesthesia revival. Bladder irrigation and urinary catheter were stopped on the first postoperative day and the subsequent discharge evaluation was conducted. The baseline data, perioperative results, rehabilitation, hospitalization expenses, functional results and complications at the first postoperative month were prospectively recorded. Results： Average age and prostate volume were 61.6±5.2 （52-75） years and 52.6 （37.7, 66.0） mL, respectively. All procedures were successfully completed with a mean operation time of 36.6 （24.0, 40.0） min. All patients were allowed to drink and drink after recovery from anesthesia. A decrease in hemoglobin was 0.8±0.3 g/dL. Average postoperative irrigation was 16.3±2.1h, and indwelling catheterization time was 22.1±3.7 h. All patients were discharged in the morning on the first postoperative day. The average hospital stay was 16.7±2.5 h, the total hospital stay was 21.6±0.5 days and the total hospitalization cost was 13130±320 RMB. The 1-month follow-up results showed a substantial improvement in the International Prostate Symptom Score from 26.7 （22.0, 29.0） to 4.5 （3.0, 6.3）, Quality of Life score from 5.0 （5.0, 6.0） to 1.5 （1.0, 2.0）, andmaximum urinary flow rate from 8.8 （5.2, 11.7） mL/s to 21.2 （16.2, 29.0） mL/s （all P< 0.001）. Five patients received indwelling catheterization after removal of the catheter. Five patients were diagnosed with anterior urethral stricture and three patients experienced bladder neck contracture. No other complications above Clavien grade II occurred in this study. Conclusion： This is the first report of ThuLEP in a ambulatory surgery mode. The preliminary results show that ambulatory surgery of ThuLEP is safe, feasible, economical and effective under the conditions of suitable patients and available techniques, and can be promoted in qualified hospitals. In addition, patients can eat and drink immediately after ThuLEP surgery, which can provide a reference for exploring and developing ThuLEP in outpatient setting or routine eating and drinking after BPH surgery.
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