Introduction

1. No. 035 Thulium end-fire laser prostatectomy – A technically flexible and easily-adaptable, cost-effective treatment with contemporary efficacy Aravin Gunasegaram BSc (Med) MBBS & Raymond Stanton MBBS FRACS Calvary Health Care, Riverina, Wagga Wagga, New South Wales Posters Proudly Supported by: Results Table 2a – Peri-operative data Table 2b – Vaporisation vsVapoenucleation efficiency Length of stay (LOS) was 1 day in most (n=35), 2 days (n=2), 3 days (n=6), 10 days (n=1 – Pre-op workup, rewarfarinisation, frail), 14 days (n=1 – Rewarfarinisation, previous CVA, rehabilitation). Duration of catheterisation was 1 day in all except 6 warfarinised patients (see above), 1 patient with mild haematuria (2 days), 1 patient who underwent concurrent hernia repair (2 days) and 1 frail patient with previous lower-limb amputation (3 days). All patients without SPC passed TOV on IDC removal (n=30). No recatheterisation was required in non-SPC dependant patients. No blood transfusions were required. Patients with SPC (n=15) had TOV deferred 3-12 weeks: 7 passed TOV and remain catheter-free. 8 failed – 1 passed TOV at 5mth after optical urethrotomy for stricture, 7 require long-term SPC due to chronic retention. Table 3 – Follow-up outcome data Significant improvement in subjective and objective parameters using different Thulium techniques in a balanced cross-section of patients is seen. There was minimal blood loss, despite ongoing anti-platelet treatment in significant proportion of patients (31%). Although 8 patients remain catheter-dependent, this was expected due to pre-existing chronic retention. Tissue vaporisation rate approaching that of electrosurgical TURP is demonstrated, with higher results using the vapo-enucleation technique. Introduction Development of various laser modalities have allowed the achievement of gold-standard conventional TURP-like functional results, with superior peri-operative safety and morbidity outcomes in treating prostatic outflow obstruction. Thulium laser prostatectomy utilising end-fire fibre offers the combined haemostatic safety of vaporisation and efficiency of enucleative resection that exist largely separately in other laser modalities. Additionally, the cost-effectiveness due to repeat-usability of end-fire fibers make it a formidable alternative laser prostate treatment Aim To report initial experience with Thulium laser prostatectomy including a previously undescribed end-fire vaporisation technique. To demonstrate its efficiency and ease of adaptability as an alternative method with acceptable safety and outcome profile Methods From Aug 2011 to July 2012, 45 privately-insured patients (age 54-90 years) were selected for Thulium laser prostatectomy after informed consent was obtained. Indications for treatment – LUTS (n=29), Recurrent acute urinary retention (n=9), Chronic retention (n=6), Bladder calculus (n=1). Previous TURP (n=24) Table 1 – Baseline Characteristics Anti-platelet/coagulant use – Aspirin (n=14, not ceased), Warfarin (n=6, ceased and re-commenced day 1), Clopidogrel (n=2, ceased and re-commenced day 10) Equipment – 140–W (CyberTM, Quanta Systems, Italy) Thulium (wavelength 2010nm) in cw-mode, 550μm bare-ended fibre (Quanta Systems, Italy) were utilised. 2 transurethral prostatectomy techniques were performed through 26Ch continuous-flow resectoscope: (1) Previously undescribed Pure End-fire Vaporisation (n=33) and (2) “Mushroom-technique” VapoEnucleation/Resection not requiring morcellation (n=12), achieving an open outflow channel as in conventional TURP. Normal saline continuous irrigation was utilised in all procedures. SPC was concurrently inserted in patients with urinary retention history (n=15). 20Ch (22Ch in warfarinised patients) IDC without irrigation was inserted post-procedure and removal planned Day 1 post-op in all except warfarinised patients, in whom this was deferred until therapeutic anti-coagulation was achieved post-recommencement. Peri-, post-operative and follow-up data, including complications, were prospectively recorded. Mean follow-up duration was 6.9 ± 3.4 (1.5-13)months. Conclusion Thulium laser prostatectomy offers results that are comparable to established contemporary techniques even in an initial single-surgeon experience. It offers vaporisation rates that are superior to established modalities, with comparable haemostasis and concurrent enucleation capability. We demonstrate the flexibility and efficiency of the re-usable, cost-effective bare-end fibre.