Prostatın Yüksek Güçlü (200w) Thulium Lazer Vapoenükleasyonu Fonksiyonel Parametreleri Nasıl Etkiliyor? Kısa Dönem Sonuçlarımız

Year 2023, Volume: 18 Issue: 3, 240 - 248, 25.10.2023

Ümit Yıldırım , Mehmet Ezer , Mehmet Uslu , Bumin Örs , Fatih Gokalp

https://doi.org/10.33719/yud.2023-18-3-1306328

Abstract

Amaç: Benign prostat hiperplazisi tedavisinde kullanılan yüksek güçlü (200 W) Thulium:YAG lazer vapoenükleasyonun etkinlik ve güvenilirliğini, bu prosedürün alt üriner sistem semptomları, erektil ve ejakülatuar fonksiyonlar üzerindeki etkisini değerlendirmek amacıyla, sunulan bu prospektif çalışmayı yürüttük.
Gereç ve Yöntemler: Aralık 2021 ile Haziran 2022 arasında, benign prostat hiperplazisinin belirti ve semptomlarını tedavi etmek için kliniğimizde Thulium vapoenükleasyon (ThuVEP) uygulanan hastaların verileri prospektif olarak toplandı. Hariç tutma kriterleri uygulandıktan sonra 50 vakalık bir örneklem büyüklüğü elde edildi. Ameliyatı takip eden 1. ve 6. aylarda tüm hastalar alt üriner sistem semptomları, erektil fonksiyon ve ejakülasyon semptomları açısından ameliyat öncesi durumları ile karşılaştırıldı. Oluşan komplikasyonları sınıflandırmak için Modifiye Clavien-Dindo Sınıflandırması da kullanıldı.
Bulgular: Hastaların IPSS skorlarında 6 aylık takip sonunda belirgin ve anlamlı bir iyileşme görüldü. Ameliyat öncesi durumla karşılaştırıldığında, IIEF-5 skoru ile ölçülen erektil fonksiyonlar ameliyatla önemli ölçüde değişmedi. Takip süresinin sonunda, MSHQ-EjD skoru ile ölçülen ejakülasyon fonksiyonlarında önemli bir bozulma oldu. İşlem sırasında ve sonrasında hastaların 2'sinde (%4) Clavien 3a seviyesinde komplikasyon görüldü, ancak bu seviyenin üzerinde komplikasyon görülmedi.
Sonuç: Semptomatik benign prostat hiperplazisinin cerrahi tedavisinde kullanılan ThuVEP yöntemi, yüksek güçlü (200 W) vapoenükleasyona rağmen fonksiyonel sonuçlar açısından güvenli ve etkilidir. Bu alanda daha uzun takipli randomize kontrollü çalışmalara ihtiyaç vardır.

Keywords

thulium , lazer , vapoenükleasyon , erektil , fonksiyonel

How Is High Power (200w) Thulium Laser Vapoenucleation of the Prostate Impacting Functional Parameters? Short-Term Follow-Up Results

Abstract

Objective: To assess the efficacy and safety of thulium laser vapoenucleation of the prostate and its impact on patient’s lower urinary tract symptoms, erectile, and ejaculatory functions, we conducted the current prospective trial employing a high-power (200 W) Thulium: YAG laser system.
Material and Methods: Between December 2021 and June 2022, we prospectively collected data on patients who underwent Thulium vapoenucleation of the prostate (ThuVEP) in our clinic to treat the signs and symptoms of benign prostatic hyperplasia. A sample size of 50 cases was obtained after applying exclusion criteria. In the first and sixth months following surgery, all patients were compared to their preoperative status in terms of lower urinary tract symptoms, erectile function, and ejaculatory symptoms. The Modified Clavien-Dindo Classification was also used to classify the complications that occurred.
Results: The patients' IPSS scores showed a notable and significant improvement at the end of the 6-month follow-up. When compared to the preoperative state, erectile functions as measured by the IIEF-5 score did not significantly change with the surgery. At the end of the follow-up period, there was a substantial deterioration of ejaculatory functions as measured by the MSHQ-EjD score. During and after the procedure, complications at the Clavien 3a level were seen in 2 (4%) of the patients, but no complications above this level were seen.
Conclusion: The ThuVEP method, used in the surgical management of symptomatic benign prostatic hyperplasia, is safe and effective in terms of functional outcomes despite high-power (200 W) vapoenucleation. In this field, further randomized controlled studies with extended follow-up are required.

Keywords

thulium , laser , vapoenucleation , erectile , functional

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