Thulium laser enucleation of the prostate in patients with large benign prostate hyperplasia and acute urinary retention

BACKGROUND: Benign prostatic hyperplasia is the most common urological disease in older men, leading to the development of bladder outlet obstruction and a decrease in the quality of life of patients. The choice of the method of surgical treatment of benign prostatic hyperplasia with large prostate volumes is the subject of discussion. There is also no unified approach to the management of patients with acute urinary retention due to benign prostatic hyperplasia.

AIM: To evaluate the results of thulium laser enucleation of the prostate in patients with large benign prostatic hyperplasia associated with acute urinary retention.

MATERIALS AND METHODS: The present study included the results of treatment of 237 patients with benign prostatic hyperplasia with a prostate volume of more than 80 cm³, of which 97 were hospitalized in the urology department for acute urinary retention. The age of the patients ranged from 51 to 89 years (average 70.2 years). The volume of the prostate gland ranged from 80 to 150 cm³ (mean 128.3 cm³). The control examination was performed on the 2^nd day, as well as 3, 6 and 12 months after the surgery.

RESULTS: Surgical intervention was performed using a thulium fiber laser device FiberLase U1 (IRE-Polyus, Russia) with a power of 120 W. The time of surgery ranged from 63 to 127 minutes (average 74.3 minutes). The irrigation system was turned off on the 1^st day of the postoperative period. The duration of urethral catheterization averaged 2.7 days. None of the patients in the study required blood transfusion or repeated surgery to coagulate the vessels of the prostate bed. After removal of the urethral catheter, all patients urinated on the first attempt. In 7 patients (2.95%), after removal of the urethral catheter, urinary incontinence was observed, during the first 6 months after the operation, urinary retention was restored in all of them. We did not note significant differences during the intra-, early and late postoperative period in operated BPH patients with and without acute urinary retention.

CONCLUSIONS: ThuLEP is an effective and safe method of surgical treatment of patients with benign prostatic hyperplasia with a prostate volume of more than 80 cm³, complicated by acute urinary retention.