title: Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: results at a single institution.
abstract: BACKGROUND
  Thulium vapoenucleation of the prostate (ThuVEP) has been introduced as a minimally invasive treatment for benign prostatic obstruction (BPO).
  
  
  OBJECTIVE
  To analyze immediate outcomes and the institutional learning curve of ThuVEP, and to report its standardized complication rates, using the modified Clavien classification system (CCS) to grade perioperative complication rates.
  
  
  METHODS
  A prospective evaluation of 1080 patients undergoing ThuVEP from January 2007 until May 2012 at our institution.
  
  
  METHODS
  ThuVEP was performed using the 2-μm, continuous-wave, thulium:yttrium-aluminum-garnet laser.
  
  
  METHODS
  Preoperative status, surgical details, and immediate outcome were recorded for each patient. Perioperative complications were classified according to the modified CCS.
  
  
  CONCLUSIONS
  Median prostate size was 51 ml (interquartile range [IQR]: 36-78.7). Median operation time was 56 min (IQR: 40-80), and median enucleation time was 32.5 min (IQR: 22-50). Median catheterization time was 2 d (IQR: 2-2); median length of hospital stay was 4 d (IQR: 3-5). Median resected tissue weight was 30 g (IQR: 16.00-51.25). Incidental carcinoma of the prostate was detected in 59 (5.5%) patients. Median maximum urinary flow rate (8.9 vs 18.4 ml/s) and postvoid residual urine volume (120 vs 20 ml) changed significantly (p<0.001). Minor complications occurred in 24.6% of the patients (Clavien 1: 20.8%; Clavien 2: 3.8%). Early reinterventions were necessary in 6.6% of the patients (Clavien 3a: 0.6%; Clavien 3b: 6%). One Clavien 4 complication occurred (0.09%). The overall complication rates decreased significantly over time due to decreasing Clavien 1, 2, and 3b events. The major limitations of the study are the prospective, unicentric study design, the lack of a control group, and that only short-term data were documented on morbidity and efficacy of the ThuVEP procedure.
  
  
  CONCLUSIONS
  ThuVEP is a safe and effective procedure for the treatment of symptomatic BPO, with low perioperative morbidity.
authors.affiliation: Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Gross
authors.forename: Christopher
authors.initials: C
authors.lastname: Netsch
authors.forename: Sophie
authors.initials: S
authors.lastname: Knipper
authors.forename: Jasmin
authors.initials: J
authors.lastname: Hölzel
authors.forename: Thorsten
authors.initials: T
authors.lastname: Bach
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D004867:Equipment Design; D005858:Germany; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation*; D053844:Lasers, Solid-State; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D013932:Thulium; D013997:Time Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization; D014554:Urination; D014563:Urodynamics
chemical_list: D013932:Thulium