ThuLEP

from Wikipedia, the free encyclopedia
This article or section is not worded in a generally understandable manner. The shortcomings are described under Discussion: ThuLEP . If you remove this module, please explain this on the article discussion page and add the automatically created project page section Wikipedia: Incomprehensible articles #ThuLEP um{{ Done | 1 = ~~~~}}.

The ThuLEP ( thulium (Tm: YAG ) - Laser - Enucleation of the Prostate ) belongs as the ThuVEP (thulium (Tm: YAG) laser Vapoenukleation) to the minimally invasive transurethral (by endoscopic mirroring through the urethra) operation method in which the entire Enlarged internal prostate gland, which is responsible for the obstructive symptoms when urinating (delayed urination, decreased urine flow, longer urination time, residual urine formation, overflow bladder, urinary retention), can be removed.

During the operation, the prostate lobes are released individually and temporarily positioned in the urinary bladder. From there they are suctioned off with the help of a morcellator (tissue grinder) and collected for the tissue examination so that the entire removed tissue and thus the entire internal prostate gland can be examined. If the internal gland of the prostate is completely removed, a renewed growth of residual prostate tissue of the internal gland as well as a recurrence (return of the symptoms) is unlikely in contrast to procedures in which only part of the prostate gland is removed (TUR-P, laser vaporization prostate) unlikely.

Operational principle

The aim of ThuLEP, which was developed and presented by Thomas RW Herrmann at the Hannover Medical School , is a complete removal of the internal prostate gland while at the same time the external prostate gland is completely intact. On the prostate gland, attached to the prostate gland (prostate capsule) from 3 ° to 9 ° between the prostate and rectum, the nerve plexus for the erection runs, which should not be affected by surgical cuts or thermal damage. In addition, the urethral sphincter engages the tip of the external gland from below (caudally). A mechanical enucleation of the prostate that is largely athermal prevents thermal damage in depth here as well. The defined and low penetration depth of the thulium (Tm: YAG) laser of approx. 250 µm also prevents deep damage at the points where hemostasis has to be performed. The external gland (prostate capsule), which is largely intact and which has to be overgrown by the mucous membrane of the bladder after the operation, is not prevented from healing by a lot of coagulated (fused) tissue.

The operation is based on the adenoma enucleation, which used to be often performed through an open incision, in which the internal prostate gland was mobilized mechanically. In contrast to this, ThuLEP can be performed minimally invasively through the urethra. Another advantage over open adenoma enucleation is the possibility of circumscribed hemostasis of the injecting vessels supplying the internal gland. The mobilization of the prostate lobes takes place along an anatomically defined layer between the inner and outer glands, which is visible to the surgeon throughout the operation. The tissue binding here is designed in such a way that one can mechanically shear off the inner gland from the outer gland. Since this procedure takes place under sight with an endoscope, the supply vessels can be set down immediately and welded with the aid of the laser. In contrast to open surgery, blood loss is therefore very low.

In contrast to ThuLEP, with ThuVEP the entire extraction point is sealed by a vaporising incision. The coagulation fringe is also constantly superficial here in accordance with the low penetration depth of the laser.

Regeneration process after the operation

After the operation, the urinary tract is splinted for a short period using a transurethral balloon catheter and the urinary bladder is flushed. After removing the catheter, the internal wound healing is not yet complete. The urine now comes into contact with the collection point of the internal gland in the prostate bed. This can temporarily and rarely until the wound surface has healed completely after 3 to 6 weeks, causing irritation symptoms such as frequent and sudden urges to urinate. The obstructive symptoms usually disappear after removal of the indwelling catheter, if the bladder muscle detrusor was intact before the operation. The functionality of the detrusor can be evaluated prior to the operation using computer-assisted urodynamics . This examination should be carried out in all elderly patients, if there is a suspicion of an underlying neurological disease (e.g. Parkinson's disease , dementia ) and if an insufficient (i.e. too weak) detrusor (high residual urine, prolonged urinary retention, high bladder filling volumes) is suspected .

Compared to standard procedures, aftercare

For the classification of ThuLEP there are two randomized controlled studies (RCTs), which correspond to the evidence level EBL Ib, as well as a larger prospective observational study. One RCT study reports a follow-up period of 18 months compared to holmium laser enucleation of the prostate HoLEP , the other with a short follow-up period of three months compared to transurethral prostate resection (TURP). The RCT by Zhang et al. showed an equivalence between thuLEP and HoLEP, as there were no significant differences in the changes in relation to the symptomatic parameters or parameters that could be checked in urodynamics, differences with advantages for ThuLEP resulted in terms of blood loss and hemostasis, advantages for HoLEP resulted in terms of the operating time . In the study by Świniarsk et al. In the three-month follow-up period, there were no differences in efficacy or surgical morbidity.

Individual evidence

  1. ↑ TR Herrmann, EN Liatsikos, U. Nagele, O. Traxer, AS Merseburger: EAU Guidelines Panel on laser technologies. EAU guidelines on laser technologies . In: European Urology . tape 61 , no. 4 , April 2012, p. 783-795 , PMID 22285403 .
  2. ↑ T. Bach, C. Netsch, L. Pohlmann, TR Herrmann, AJ Gross: Thulium: YAG vapoenucleation in large volume prostates . In: The Journal of Urology . tape 186 , 2011, p. 2323-2327 , PMID 22014812 .
  3. ↑ T. Bach, SJ Xia, Y Yang, S. Mattioli, GM Watson, AJ Gross, TR Herrmann: Thulium: YAG 2 mum cw laser prostatectomy: where do we stand? In: World Journal of Urology . tape 28 , no. 2 , April 2010, p. 163-168 , PMID 20204378 .
  4. ↑ A. Gabuev, M. Oelke: Current aspects on epidemiology, diagnosis and therapy of benign prostatic syndrome (Latest trends and recommendations on epidemiology, diagnosis, and treatment of benign prostatic hyperplasia (BPH)) . In: Current Urology . tape 42 , no. 3 , May 2011, p. 167-178 , PMID 21604233 .
  5. ↑ M. Oelke, M. Burger, D. Castro-Diaz, E. Chartier-Kastler, MA Cidre, T. McNicholas, P. Radziszewski, M. Kirby: Diagnosis and medical treatment of lower urinary tract symptoms in adult men: applying specialist guidelines in clinical practice . In: BJU International . 2011, doi : 10.1111 / j.1464-410X.2011.10808.x , PMID 22145967 .
  6. ↑ Fabrizio Iacono, Domenico Prezioso, Giovanni Di Lauro, Giuseppe Romeo, Antonio Ruffo, Ester Illiano, Bruno Amato: Efficacy and safety profile of a novel technique, ThuLEP (Thulium laser enucleation of the prostate) for the treatment of benign prostate hypertrophy. Our experience on 148 patients . In: BMC surgery . tape 12 , Suppl 1, January 2012, ISSN  1471-2482 , p. S21 , doi : 10.1186 / 1471-2482-12-S1-S21 , PMID 23173611 .
  7. ↑ a b Fengbo Zhang, Qiang Shao, Thomas RW Herrmann, Ye Tian, ​​Yuhai Zhang: Thulium laser versus holmium laser transurethral enucleation of the prostate: 18-month follow-up data of a single center . In: Urology . tape 79 , no. 4 , April 2012, ISSN  1527-9995 , p. 869-874 , doi : 10.1016 / j.urology.2011.12.018 , PMID 22342411 .
  8. ↑ a b Piotr Paweł Świniarski, Stanisław Stępień, Waldemar Dudzic, Stanisław Kęsy, Mariusz Blewniewski, Waldemar Różański: Thulium laser enucleation of the prostate (TmLEP) vs. transurethral resection of the prostate (TURP): evaluation of early results . In: Central European Journal of Urology . tape 65 , no. 3 , January 2012, ISSN  2080-4806 , p. 130-134 , doi : 10.5173 / ceju.2012.03.art6 , PMID 24578948 .