Presented by: Carlotta Nedbal MD
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy AND Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.

Introduction

To compare surgical and functional enucleation outcomes in a real-world multicentre practice using high-power Holmium laser (HP-HoLEP) and Thulium fiber laser enucleation of the prostate (ThuFLEP) for different prostate sizes.

Materials

4216 patients who underwent HP-HoLEP or ThuFLEP in 8 centers from 7 countries between 2020 and 2022 were included. Exclusion criteria were previous urethral or prostatic surgery, radiotherapy, concomitant surgery.

Results

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Propensity score matching (PSM) analysis retrieved 563 patients in each cohort to adjust for the bias inherent to different characteristics at baseline. Outcomes included incidences of postoperative incontinence, early complications (30-day), and delayed complications; and measurements of the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and post-void residual (PVR). After PSM, 563 patients in each arm were included. Total operative time was similar, but enucleation and morcellation times were significantly longer for ThuFLEP. Postoperative acute urinary retention was higher in the ThuFLEP arm (3.6% vs 0.9%, p=0.005), but 30-day readmission was higher in the HP-HoLEP arm (22% vs 8%, p=0.016). There was no difference in postoperative incontinence rates (HP-HoLEP:19.7%, ThuFLEP:16.0%, p=0.120). Rates of other early and delayed complications were low and comparable. ThuFLEP had higher Qmax (p<0.001) and lower PVR (p<0.001) than HP-HoLEP at 1-year follow-up. This study is limited by its retrospective nature.

Conclusion

This real-world study shows that early and delayed outcomes of enucleation with ThuFLEP are comparable to HP-HoLEP, with similar improvement in micturition parameters and IPSS. As lasers become readily available, urologists should focus on performing a good anatomical prostate enucleation, with the laser only an adjunct for good surgery. Patients should be counseled about long-term complications even in experienced hands.

Funding

None

Lead Authors

Vineet Gauhar,
Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore.

Daniele Castellani,
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.

Co-Authors

Khi Yung Fong,
Yong Loo Lin School of Medicine, National University of Singapore

Mario Sofer,
Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Rodríguez Socarrás,
Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain

Azimdjon Tursunkulov,
Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan

Lie Kwok Ying,
Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore

Dean Elterman,
Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada

Abhay Mahajan,
Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India.

Tanuj Bhatia,
Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, Haryana, India

Dmitry Enikeev,
Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation

Nariman Gadjiev,
Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia.

Mallikarjuna Chiruvella,
Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, TG, India.

Jeremy Teoh,
S.H.Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China

Andrea Galosi, Professor
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.

Fernando Gómez Sancha,
Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain

Bhaskar Somani, Professor
Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK

Thomas Herrmann, Professor
Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland