Different lasers have been developed for treatment of benign prostatic hyperplasia, with no definitively superior technique identified to date.
To compare surgical and functional enucleation outcomes in real-world multicentre practice using high-power holmium laser (HP-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) for different prostate sizes.
The study included 4216 patients who underwent HP-HoLEP or ThuFLEP at eight centers in seven countries between 2020 and 2022. Exclusion criteria were previous urethral or prostatic surgery, radiotherapy, or concomitant surgery.
To adjust for the bias arising from different characteristics at baseline, propensity score matching (PSM) was used to identify 563 matched patients in each cohort. Outcomes included the incidence of postoperative incontinence, early complications (30-d), and delayed complications, and results for the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual volume (PVR).
After PSM, 563 patients in each arm were included. Total operative time was similar between the arms, but enucleation and morcellation times were significantly longer for ThuFLEP. The rate of postoperative acute urinary retention was higher in the ThuFLEP arm (3.6% vs 0.9%; p = 0.005), but the 30-d readmission rate 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 between the arms. The ThuFLEP group had higher Qmax (p < 0.001) and lower PVR (p < 0.001) than the HP-HoLEP group at 1-yr follow-up. The study is limited by its retrospective nature.
This real-world study shows that early and delayed outcomes of enucleation with ThuFLEP are comparable to those with HP-HoLEP, with similar improvements in micturition parameters and IPSS.
As lasers become readily available for the treatment of enlarged prostates causing urinary bother, urologists should focus on performing good anatomic removal of prostate tissue, with the choice of laser not as important for good outcomes. Patients should be counseled about long-term complications, even when the procedure is being performed by an experienced surgeon.
European urology focus. 2023 Jul 04 [Epub ahead of print]
Vineet Gauhar, Carlotta Nedbal, Daniele Castellani, Khi Yung Fong, Mario Sofer, Moisés Rodríguez Socarrás, Azimdjon N Tursunkulov, Lie Kwok Ying, Dean Elterman, Abhay Mahajan, Vladislav Petov, Sorokin Nikolai Ivanovich, Tanuj Paul Bhatia, Dmitry Enikeev, Nariman Gadzhiev, Mallikarjuna Chiruvella, Jeremy Yuen-Chun Teoh, Andrea Benedetto Galosi, Fernando Gómez Sancha, Bhaskar Kumar Somani, Thomas R W Herrmann
Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy; Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK. Electronic address: ., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain., Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan., Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada., Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India., Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Urology Division, Lomonosov Moscow State University, Moscow, Russia., Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India., Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Vienna Medical University, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria., Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia., Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India., S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.