title: Thulium laser (RevoLix) vaporesection versus vapoenucleation with morcellator (Piranha) for the treatment of benign prostatic obstruction: a propensity-matched multicenter analysis.
abstract: OBJECTIVE
  To compare the efficacy and safety of vaporesection without a morcellator, and vapoenucleation with a morcellator in thulium laser prostatectomy for the treatment of benign prostatic obstruction.
  
  
  METHODS
  Between March 2010 and January 2013, 405 patients underwent thulium:yttrium-aluminium-garnet laser prostatectomy. Among these patients, 150 patients who underwent thulium:yttrium-aluminium-garnet laser prostatectomy without a morcellator (n = 75) or with a morcellator (n = 75) were analyzed in a propensity matching study. Outcome measures included International Prostate Symptom Score, quality of life score, maximum flow rate, postvoid residual, total operating time, laser time and resected tissue weight.
  
  
  RESULTS
  No significant differences were noted between the thulium:yttrium-aluminium-garnet laser prostatectomy without a morcellator and thulium:yttrium-aluminium-garnet laser prostatectomy with a morcellator groups, including the prostate volume (50.3 vs 51.9 mL) and postoperative prostate volume (22.4 vs 18.7 mL). However, there were differences between the groups in total operating time (72.8 vs 61.0 min, P = 0.023) and laser activating time (24.5 vs 19.9 min, P = 0.037). Thulium:yttrium-aluminium-garnet laser prostatectomy with a morcellator showed greater resected tissue volume than thulium:yttrium-aluminium-garnet laser prostatectomy without a morcellator (9.0 vs 18.2 g, P = 0.029). There were also significant differences in total retrieval efficiency (1.14 vs 1.67 g/min, P = 0.031). There were no significant differences in improvement of International Prostate Symptom Score, quality of life scores and urodynamic findings between the two groups, except for the International Prostate Symptom Score (11.2 vs 7.3, P = 0.028) at 6 weeks after surgery.
  
  
  CONCLUSIONS
  Thulium:yttrium-aluminium-garnet laser prostatectomy with a morcellator provides superior reduction of prostate volume and better short-term clinical outcomes than thulium:yttrium-aluminium-garnet laser prostatectomy without a morcellator in the treatment of patients with benign prostatic obstruction. Furthermore, thulium:yttrium-aluminium-garnet laser prostatectomy with a morcellator can offer a shorter operative time.
authors.affiliation: Department of Urology, Haeundae Paik Hospital, Inje University, Busan, Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Chung
authors.forename: Pil Moon
authors.initials: PM
authors.lastname: Kang
authors.forename: Won Ik
authors.initials: WI
authors.lastname: Seo
authors.forename: Cheol Kyu
authors.initials: CK
authors.lastname: Oh
authors.forename: Seong Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Park
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Jang Ho
authors.initials: JH
authors.lastname: Yoon
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Kang
authors.forename: Jae Il
authors.initials: JI
authors.lastname: Chung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011468:Prostatectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013932:Thulium; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery*
chemical_list: D013932:Thulium
keywords: laser therapy; prostatatic hyperplasia; thulium; vapoenucleation; vaporesection