Thulium Laser energy versus Bipolar current in transurethral enucleation of large prostates; a multicenter prospective randomized study

Abstract Purpose: Endoscopic enucleation of the prostate (EEP) was introduced to treat patients with large prostate. The study compared Bipolar current and Thulium laser in endoscopic enucleation of large prostates above 80 gm. Methods: This is a prospective conducted study of 120 male patients. The patients were randomized equally into two groups (Thulium vapo-enucleation and bipolar enucleation). All patients were preoperatively evaluated; we monitored Operative time hemoglobin drop, intraoperative and early postoperative complications, hospital stay, and time of catheter removal. All patients followed up at 1, 3, 6, and 12 months to detect urinary and sexual functional outcome and any postoperative complications. Results: The preoperative characteristics of both groups were comparable. The mean prostate volume in ThuVEP group was 122.33 ± 24.34 and in bipolar group was 120.88 ± 25.66, (P value: 0.751). We found significant comparable improvement in IPSS score, urinary Q max, and PVR postoperatively in both groups at all follow up points. After one month, urgency urinary incontinence was reported in 34 (56.7%) cases in ThuVEP and 14 (23.3%) cases in bipolar enucleation group respectively (P value 0.001), and stress urinary insentience was in 44 (73.3%) cases in ThuVEP and 26 (43.3%) cases in bipolar enucleation group respectively (P value 0.001). Both types of incontinence improved after 3 months in both groups , three cases in ThuVEP group had persistent stress incontinence after one year. Conclusion: ThuVEP and bipolar enucleation are comparable treatment modalities for large prostate (>80 ml).