title: Thulium laser resection versus plasmakinetic resection of prostates larger than 80 ml.
abstract: OBJECTIVE
  To compare the safety and efficiency of thulium laser resection of the prostate-tangerine technique (TmLRP-TT) and plasmakinetic resection of the prostate (PKRP) for aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates (>80 ml) in a prospective randomized trial with an 18-month follow-up.
  
  
  METHODS
  From January 2010 to November 2011, 90 BPH patients with large volume prostates were randomized for surgical treatment with TmLRP-TT (n = 45, group 1) or PKRP (n = 45, group 2). The preoperative and postoperative parameters were recorded and compared. All patients were evaluated at 1, 6, 12 and 18 months postoperatively using the International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Q max), postvoid residual urine volume (PVR) and the five-item version of the International Index of Erectile Function score. All perioperative complications were also documented and classified according to the modified Clavien classification system.
  
  
  RESULTS
  Compared with the PKRP group, the TmLRP-TT group had a statistically lower hemoglobin drop (0.86 ± 0.42 vs. 1.34 ± 1.04 g/dl, P < 0.01), shorter catheterization time (1.91 ± 0.85 vs. 2.36 ± 0.74 days, P < 0.01) and hospital stay (3.80 ± 0.46 vs. 5.02 ± 0.54 days, P < 0.01). Within the observation period of 18 months, both groups had significant postoperative improvement in IPSS, QoL, Q max and PVR, although no difference was observed between the two groups. Only one patient receiving PKRP treatment required a blood transfusion perioperatively. During the 18-month follow-up, one patient in each group experienced urethral stricture and one patient in the PKRP group experienced bladder neck contracture. Minor complications that required no or noninterventional treatment occurred in 6 (13.33 %) of TmLRP-TT group (Clavien grade 1, 13.33 % and grade 2, 0 %) and 10 (22.22 %) of PKRP group (Clavien grade 1, 20.00 % and grade 2, 2.22 %). No severe complications required reinterventions in both groups (Clavien grade 3, 0 %; grade 4, 0 %; grade 5, 0 %).
  
  
  CONCLUSIONS
  Both TmLRP-TT and PKRP are safe and effective treatment options for large prostates that require resection. Taking into account less blood loss, shorter catheterization time and hospital stay, TmLRP-TT may be a better treatment for patients with large prostates.
authors.affiliation: Department of Urology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China.
authors.forename: Haibin
authors.initials: H
authors.lastname: Wei
authors.forename: Yi
authors.initials: Y
authors.lastname: Shao
authors.forename: Feng
authors.initials: F
authors.lastname: Sun
authors.forename: Xiaowen
authors.initials: X
authors.lastname: Sun
authors.forename: Jian
authors.initials: J
authors.lastname: Zhuo
authors.forename: Fujun
authors.initials: F
authors.lastname: Zhao
authors.forename: Bangmin
authors.initials: B
authors.lastname: Han
authors.forename: Juntao
authors.initials: J
authors.lastname: Jiang
authors.forename: Huirong
authors.initials: H
authors.lastname: Chen
authors.forename: Shujie
authors.initials: S
authors.lastname: Xia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D013932:Thulium; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology
chemical_list: D013932:Thulium