title: Five-year outcomes of thulium vapoenucleation of the prostate for symptomatic benign prostatic obstruction.
abstract: OBJECTIVE
  To assess the 5-year outcomes of thulium vapoenucleation of the prostate (ThuVEP) in patients with benign prostatic obstruction (BPO) retrospectively.
  
  
  METHODS
  Five-hundred patients were treated with ThuVEP between January 2007 and January 2010 at our institution. Patients were reassessed 1 and 5-years after ThuVEP with International Prostate Symptom Score (IPSS), Quality of Life (QoL), urinary peak flow (Qmax), postvoid residual volume (PVR), PSA and prostate volume. Patient data were expressed as median (interquartile range).
  
  
  RESULTS
  One-hundred and thirty-one patients completed the 5-year follow-up. According to preoperative prostate volume, patients were divided into two groups: group A (<60 ml, n = 80) and B (≥60 ml, n = 51). IPSS, QoL, Qmax, and PVR improved significantly at discharge and continued to do so during 5-year follow-up (p ≤ 0.001). At 1-year follow-up, prostate volume had decreased significantly (50 vs. 13 mL, p < 0.001) corresponding to a prostate volume reduction of 80.8%. PSA was significantly reduced at 5-year (0.72 µg/l) follow-up compared to preoperative PSA (3.39 µg/l, p ≤ 0.001). PSA-reduction (total 77.1%) at 5-year follow-up was significantly different between group A (70.2%) and B (83.5%) (p ≤ 0.006). IPSS was significantly lower in group B than in A (2.5 vs. 6, p < 0.001) at 5-year follow-up. Bladder neck contractures (n = 4) and urethral strictures (n = 4) occurred in 3.1% of the patients each. Three patients (2.3%) were re-treated for regrowth of prostatic tissue.
  
  
  CONCLUSIONS
  ThuVEP is a durable procedure with regard to micturition improvement and PSA-reduction. The reintervention rate after ThuVEP was low during long-term follow-up.
authors.affiliation: Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22307, Hamburg, Germany.
authors.forename: A J
authors.initials: AJ
authors.lastname: Gross
authors.affiliation: Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22307, Hamburg, Germany.
authors.forename: A K
authors.initials: AK
authors.lastname: Orywal
authors.affiliation: Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22307, Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Becker
authors.affiliation: Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22307, Hamburg, Germany. c.netsch@asklepios.com.
authors.forename: C
authors.identifier: http://orcid.org/0000-0001-5685-0731
authors.initials: C
authors.lastname: Netsch
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods; D053844:Lasers, Solid-State / Q000627:therapeutic use; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology; D008297:Male; D009929:Organ Size; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D019233:Retreatment / Q000706:statistics & numerical data; D063189:Symptom Assessment; D013932:Thulium / Q000627:therapeutic use*; D014524:Urethral Obstruction / Q000175:diagnosis / Q000209:etiology
chemical_list: D013932:Thulium
keywords: BPO; Benign prostatic obstruction; Laser surgery, Tm:YAG; Lasers; Long-term; PSA; ThuVEP; Vapoenucleation