A prospective randomized comparative analysis of bipolar TURP and high-power Thulium vapoenucleation in the management of benign prostatic hyperplasia.

Background: Benign prostatic hyperplasia is on the rise as the life expectancy has been increased due to medical advancements. TURP once a gold standard is now slowly been replaced by lasers. As patients continue seeking less invasive and more efficient treatment options, they must be provided with evidence-based treatment options . Studies using 200-watt thulium lasers are scant and have a mixed population of small and large prostates. This study focuses mainly on large prostates(>60 cc) avoiding the biases in operating time and hospital stay and intends to to compare efficacy and outcomes of bipolar transurethral resection of the prostate (TURP) vs High power thulium vapoenucleation of the prostate (ThuVEP) in benign enlargement of the prostate. Methods: A total of 68 patients were included in our study of which 34 were randomly divided in 2 arms viz Bipolar TURP group V/s ThuVEP with a prostate size of more than 60 ccs.. An analytical between-group comparison was made of preoperative and perioperative data including operation time, intraoperative blood loss by measuring spothemoglobin on postoperative day 1, hospital stay, intra-operative and perioperative complications like capsular perforation, bleeding requiring transfusion, urinary tract infections, etc. Postoperative data was collected at 2 weeks, 6 weeks, and 3 months after surgery on IPSS, uroflowmetry with PVR, and residual prostate size at 3 months. Post-operative complications like SUI, urethral strictures, bladder neck stenosis, and the need for surgery for residual adenoma, were also compared. Results: ThuVEP was associated with statistically significant shorter resection time, lesser requirement of irrigation fluid in the postoperative period, less blood loss, & shorter hospital stay. IPSS, PVR, and voiding time were comparable between the 2 groups. The ThuVEP group had better Qmax and Qavg and residual prostate size at all times during follow-up. The two groups were similar in terms of complications. Conclusion: Both procedures could be performed with equal safety in larger prostates. However, ThuVEP outperformed Bipolar TURP in terms of blood loss, hospital stay , post-operative uroflow parameters, and residual prostate size.