title: Analysis of early morbidity and functional outcome of thulium: yttrium-aluminum-garnet laser enucleation for benign prostate enlargement: patient age and prostate size determine adverse surgical outcome.
abstract: OBJECTIVE
  To evaluate complications and functional outcome and to identify patient-associated risk factors, we analyzed consecutive patients undergoing thulium:yttrium-aluminum-garnet laser enucleation of the prostate (ThuLEP) in our department.
  
  
  METHODS
  A total of 234 patients were prospectively analyzed. Preoperative data, postoperative complications, and outcome at 6, 12, and 24 months were recorded. Individual risk factors for complications and treatment failure were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  Mean age at surgery was 72.88 ± 7.83 years. Mean preoperative prostate size was 84.8 ± 34.9 mL. Thirty-day complication rate was 19.7%. Functional treatment failure occurred in 9.0% of all patients. Decline of mean International Prostate Symptom Score was -75%, quality of life index -76%, and postvoid residual -86% at 24 months. Maximum urine flow at 24 months was improved at +231%. In univariate analysis, age >80 years and prostate size <50 mL were significant predictors of complications, which was confirmed by multivariate analysis (P = .0277 and .0409, respectively). Age >80 years, prostate size <80 mL or <50 mL, and American Society of Anesthesiologists classification were significant predictors of functional treatment failure in univariate analysis. Prostate size <80 mL or <50 mL was significantly associated with treatment failure (P < .001) in multivariate analysis.
  
  
  CONCLUSIONS
  ThuLEP is a safe and efficient surgical procedure, even in a patient cohort with high prostate volumes, age, and comorbidities. However, high patient age and small prostate size were significant determinants of adverse outcomes after surgery. To address the question of optimal therapy selection for patients with prostates smaller than 80 mL, further prospective randomized evaluation of ThuLEP and alternative surgical interventions is needed.
authors.affiliation: Department of Urology, Klinikum Fulda, Fulda, Germany; Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany. Electronic address: steffen.rausch@med.uni-tuebingen.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Rausch
authors.affiliation: Department of Urology, Klinikum Fulda, Fulda, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Heider
authors.affiliation: Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Bedke
authors.affiliation: Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kruck
authors.affiliation: Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.affiliation: Department of Urology, Klinikum Fulda, Fulda, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Fischer
authors.affiliation: Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: Department of Urology, Klinikum Fulda, Fulda, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Kälble
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000535:Aluminum / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology* / Q000601:surgery*; D020127:Recovery of Function; D012307:Risk Factors; D013932:Thulium / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D015019:Yttrium / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: C503779:yttrium-aluminum-garnet; D015019:Yttrium; D013932:Thulium; D000535:Aluminum