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Published on September 05, 2019

Thulium Enucleation Surgery Alleviates BPH Symptoms

The risk of benign prostatic hyperplasia increases as men age, with occurrence rates of 20%, 60% and 70% for men in their 50s, 60s and 70s, respectively. Each year, about 350,000 of these men require treatment to alleviate their BPH-caused urinary dysfunction.

Traditionally, medications and transurethral resection of the prostate were the preferred treatment modalities. However, several minimally invasive procedures have gained ground, including thulium laser enucleation, which is available at only a couple of hospitals, including North Kansas City Hospital.

“For patients with very large prostates, TURP is not ideal,” said Gerald Y. Park, MD, a urologist with Kansas City Urology Care and NKCH medical staff president. Anything over 100 grams is considered very large, but with ThuLEP I can treat very large prostates. I have even treated a 380-gram prostate via ThuLEP. Enucleation is quicker, more effective and safer than TURP because the entirety of the enlarged prostate can be removed more efficiently and more safely.”

Initial Treatment

enlarged prostate

An enlarged prostate can severely restrict urination in older men. 

Treatment for BPH typically begins with medications: alpha blockers that relax the prostate and 5-alpha-reductase inhibitors that shrink the prostate. They can also be used in combination.

However, some patients are reticent to take medications, have medication allergies or stop responding to the medications.

“As men age and the prostate grows, it restricts urination,” Dr. Park said. “These patients typically continue to experience nocturia. Other complaints include a weak urine stream or one that stops and starts, dribbling, hesitancy with urination or an inability to completely void.”

ThuLEP

ThuLEP is performed by inserting a laser through a cystoscope passed through the urethra. Once at the prostate, the surgeon uses the laser to enucleate the obstructing tissue.

Dr. Park likens ThuLEP to coring an apple, with the adenoma representing the core.

“Just as one would carve out an apple core, I carve out the adenoma and leave the cut-away part behind,” Dr. Park said. “Then I push the adenoma into the bladder, where I have room to safely grind the tissue with a morcellator for removal via the urethral cystoscope.”

During the procedure, patients are sedated. The surgery takes one to two hours, depending on the size of the prostate. Patients who take anticoagulants should be off their medications for surgery. They return home the same day with a mild pain medication and a catheter, which is removed after three days.

Recent Studies

A study published in the January-March 2016 issue of Urology Annals looked at 236 patients with symptomatic BPH who were treated with ThuLEP from March 2010-September 2014. ThuLEP was a highly effective procedure as compared to all other procedures in terms of catheterization time, hospital stay and drop in hemoglobin.

Another study, published in Endoluminal Endourology in August 2018, evaluated the six-year experience of ThuLEP at one United Kingdom hospital. In all, 222 patients underwent the ThuLEP procedure performed by two surgeons. Researchers found a 159% improvement in maximum urinary flow rates and a 61% improvement in post-void residual urine tests.

Gerald Y. Park, MD

Gerald Y. Park, MDDr. Park earned his medical degree from the University of Texas Medical Branch, and he completed his residency in urology at the University of Kansas School of Medicine.