Safety and Efficacy of Transurethral Focal Laser Ablation of Prostatic Adenoma in Comparison with Transaurethral Prostatectomy for Management of Benign Prostatic Adenoma Comparative Randomized Prospective Study

Abstract Background Transurethral resection of the prostate (TURP) is considered the gold standard therapeutic approach in cases of average size prostate (30-80 grams). However, TURP is associated with possible intra- operative complications as bleeding (particularly in patients on anticoagulants treatment), steep learning curve and intravasation of hypotonic fluid with risk of TUR syndrome. Aim of the Work to compare the short term effectiveness, safety and complications Of transurethral focal laser ablation of prostatic adenoma (TU-FLAP) in comparison to monopolar TURP of prostate For Management Of benign prostatic adenoma. Patients and Methods A prospective randomized controlled study was conducted at Ain Shams university hospitals at the period from June 2021 till June 2023. 50 patients (25 in each group), group A underwent monopolar TURP under spinal anesthesia, Group B underwent TU-FLAP under local anesthesia by applying 15 watt of 980 nm diode laser through 600µm end firing fiber in the lateral and median lobe about 1.5 cm away from bladder neck with 1 cm distance between each puncture. We inserted the fiber 5 mm in depth in each puncture to fire laser for 2 minutes at each point. Number of points is correlated to supra-montanal length. Follow up was done at 1st week, 1st, 3rd and 6th months postoperative by improvement of IPSS, PAUS, PSA and uroflowmetry. Results There was no significant difference between the 2 groups as regard preoperative base line clinical and urological data average age was (67.56 ± 8.0) years, (66.08 ± 8.04) years in group A and group B respectively prostate size was 64.60 ± 16.6 gm, 57.8 ± 12.68 gm in group A and group B respectively, Median PSA (IQR) 2.7 (1.1-4.3), 3.4 (1.57-4.7) in group A and group B respectively, mean Q max 10.2±4.16, 8.16 ±3.5 in group A and group B respectively, (IPSS) total; Median (IQR) 24(23-27), 23(21-28) in group A and group B respectively, PVRU; Median (IQR) 220(186-500)ml, 750(620-850) ml in group A and group B respectively. After operation there was highly significant difference in favor of TURP in (prostate size, PSA and PVRU) as mean prostate size decreased to (38.12±10.91) mg and decreased to (47.28±10.6) mg in group A and group B respectively, PSA decreased to Median(IQR) 1 (1-2) and 3.5 (1.5-4.2) in group A and group B respectively and PVRU decreased to (median (IQR) 50(15-65)ml and100(50-150)ml in group A and group B respectively. The favourable difference toward TURP was not statistically significant in Q-max and IPSS scrore, Q max increased to 18.7±4.45 and 18.34±5.47 in group A and group B respectively and IPSS median decreasd to (IQR) 12(12-16), 6(5-9) in group A and group B respectively. However, FLAP was better as regard operative time and incidence of moderate to severe complications (operative time median (IQR) 60 (50-100) minutes, 30 (25-35) minutes in group A and group B respectively, moderate to sever complication according to modified Clavien_Dindo classification of post operative complications 24.0%, 4.0% in group A and group B respectively. Conclusion TURP is still considered the gold standard surgical approach for management of BPH, however FLAP showed favorable outcomes in comparison as it is less invasive procedure with significant decrease post-operative complications and shorter operative time especially with patients with multiple co- morbidities. Further long-term investigations are warranted for comprehensive evaluation.