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

Abstract

Objective:

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

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 2 attempts of catheter removal. Patients were investigated with flowmetry and the self-administered international prostate symptom score questionnaire at 30 and 90 days following thulep.

Results:

Three hundred eighty-one patients underwent thulep, and 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 postoperative day, in 31 patients on the second postoperative day, in 5 patients on the third postoperative day, in 6 patients on the fourth postoperative day, in 1 patient on the fifth postoperative day, and in 2 patients each on the sixth and seventh postoperative days. 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 international prostate symptom score dropped from 21.33 preoperatively to 3.2 (p = .004) at 90 days postoperatively.

Conclusion:

This prospective study shows that thulep is a safe and effective approach in refractory urinary retention patients. In our case series, no patients required postoperative intermittent catheterization. All functional outcomes investigated reported a statistical significant improvement.

Author

Carmignani L, Pastore AL, Picozzi SC, Finkelberg E, Ratti D, Vizziello D, Schirinzi ML, Saccà A, Pisano F, Maruccia S.