• Logo
  • SBMUJournals

Combination of Thulium Laser Incision and Bipolar Resection Offers Higher Resection Velocity than Bipolar Resection Alone in Large Prostates

Kuan Chun Huang, Yung Chiong Chow, Marcelo Chen, Allen W. Chiu



Purpose: We compared the efficacy and safety of a combined thulium laser incision and bipolar resection of prostate technique (web procedure) with traditional bipolar TURP.

Materials and Methods: We reviewed the medical records of 96 web procedure, 93 traditional bipolar TURP patients between 2013 and 2016. The web procedure consisted of thulium laser incision of the prostate at 3, 5, 7, 9 and 12 o’clock positions up to the resection plane and subsequent bipolar resection of the created prostate blocks.  Resected tissue weight, operative time, resection velocity, complications, blood loss, and early operative outcome were compared.

Results: No significant differences were noted among the web procedure (web group) and traditional bipolar TURP in preoperative PSA ( 6.3 vs 8.7 ng/mL, P =0.295), preoperative postvoid residual urine (55.1 vs 76.4, P =.056), modified hemoglobin decrease (defined as total Hb decrease divided by the weight of the resected tissue: 0.060 vs 0.051, p=.380), complication rate (5.2% vs 5.3 %, P =.958), hospitalization (4.0 vs 4.2 days, P =.120) and catheterization (2.5 vs 3.4, p=.066). The resection velocity was higher in the web group (0.23 vs 0.17 g/ min, p=.001). In subgroup analysis, the significant difference of resection velocity between two group was showed in large prostates (>40 g: 0.25 vs 0.20 g/min, P =0.02 ) but not in the small prostate group. There was no difference in postoperative postvoid residual urine (21.9 vs 30.3 P =.231) and postvoid residual urine decrease (33.1 vs 45.5, P = .167) 2 months after surgery.

Conclusion: The combination thulium laser incision and bipolar TURP technique had a higher resection efficiency and comparable efficacy and safety than traditional bipolar TURP.


Yang, Z., T. Liu, and X. Wang, Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up. Lasers Med Sci, 2016. 31(9): p. 1797-1802.

Hirik, E., et al., Safety and Efficacy of Bipolar Versus Monopolar Transurethral Resection of the Prostate: A Comparative Study. Urol J, 2015. 12(6): p. 2452-6.

da Silva, R.D., et al., Bipolar energy in the treatment of benign prostatic hyperplasia: a current systematic review of the literature. Can J Urol, 2015. 22 Suppl 1: p. 30-44.

Xia, S.J., et al., [Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia]. Zhonghua Yi Xue Za Zhi, 2005. 85(45): p. 3225-8.

Nair, S.M., M.A. Pimentel, and P.J. Gilling, A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia). Curr Urol Rep, 2016. 17(6): p. 45.

Bach, T., et al., RevoLix vaporesection of the prostate: initial results of 54 patients with a 1-year follow-up. World J Urol, 2007. 25(3): p. 257-62.

Bach, T., et al., Feasibility and efficacy of Thulium:YAG laser enucleation (VapoEnucleation) of the prostate. World J Urol, 2009. 27(4): p. 541-5.

Dindo, D., N. Demartines, and P.A. Clavien, Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004. 240(2): p. 205-13.

Reich, O., et al., Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol, 2008. 180(1): p. 246-9.

Herrmann, T.R., et al., EAU guidelines on laser technologies. Eur Urol, 2012. 61(4): p. 783-95.

Bach, T., et al., Prospective assessment of perioperative course in 2648 patients after surgical treatment of benign prostatic obstruction. World J Urol, 2017. 35(2): p. 285-292.

Bouchier-Hayes, D.M., et al., KTP laser versus transurethral resection: early results of a randomized trial. J Endourol, 2006. 20(8): p. 580-5.

Al-Ansari, A., et al., GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. Eur Urol, 2010. 58(3): p. 349-55.

Fraundorfer, M.R. and P.J. Gilling, Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol, 1998. 33(1): p. 69-72.

Lourenco, T., et al., Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomised controlled trials. BMJ, 2008. 337: p. a449.

Huang, X., et al., Comparison of the microvessel diameter of hyperplastic prostate and the coagulation depth achieved with mono- and bipolar transurethral resection of the prostate. A pilot study on hemostatic capability. Scand J Urol Nephrol, 2008. 42(3): p. 265-8.

Fu, W.J., et al., Comparison of 2-microm continuous wave laser vaporesection of the prostate and transurethral resection of the prostate: a prospective nonrandomized trial with 1-year follow-up. Urology, 2010. 75(1): p. 194-9.

Chung, J.S., et al., Thulium laser (RevoLix) vaporesection versus vapoenucleation with morcellator (Piranha) for the treatment of benign prostatic obstruction: a propensity-matched multicenter analysis. Int J Urol, 2014. 21(11): p. 1156-61.

Iacono, F., et al., 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. BMC Surg, 2012. 12 Suppl 1: p. S21.

Shih, H.J., et al., Laser-assisted bipolar transurethral resection of the prostate with the oyster procedure for patients with prostate glands larger than 80 mL. Urology, 2013. 81(6): p. 1315-9.

Barbalat, Y., et al., Evidence of the efficacy and safety of the thulium laser in the treatment of men with benign prostatic obstruction. Ther Adv Urol, 2016. 8(3): p. 181-91.

Kim, S.H., et al., Severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser enucleation and morcellation of the prostate: a case report. Korean J Anesthesiol, 2016. 69(2): p. 185-8.

Netsch, C., et al., A prospective, randomized trial comparing thulium vapoenucleation with holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic obstruction: perioperative safety and efficacy. World J Urol, 2017. 35(12): p. 1913-1921.

Xie, T., et al., The Effectiveness and Safety of Transurethral (Bipolar) Plasmakinetic Resection of Prostate Combined with Thulium Laser for Large Benign Prostatic Hyperplasia (>80ml). Urol J, 2016. 13(6): p. 2889-2892.

Seki, N., et al., Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases. J Urol, 2003. 170(5): p. 1847-50.

Elshal, A.M., et al., Prospective Assessment of Learning Curve of Holmium Laser Enucleation of the Prostate for Treatment of Benign Prostatic Hyperplasia Using a Multidimensional Approach. J Urol, 2017. 197(4): p. 1099-1107.

Kyriazis, I., et al., Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement. World J Urol, 2015. 33(4): p. 525-30.

Zhao, C., et al., Thulium Laser Resection Versus Plasmakinetic Resection of Prostates in the Treatment of Benign Prostate Hyperplasia: A Meta-Analysis. J Laparoendosc Adv Surg Tech A, 2016. 26(10): p. 789-798.

DOI: http://dx.doi.org/10.22037/uj.v0i0.4363