Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate.
All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications.
Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤2, according to the Clavien-Dindo classification.
With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data.
TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.
Actas urologicas espanolas. 2024 Feb 16 [Epub ahead of print]
J Romero Otero, J Justo Quintas, E García Rojo, R Sopeña Sutil, E Peña Vallejo, F Lista Mateos, G Bozzini, D Saenz Calzada, A Rodríguez Antolín, B García Gómez
Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain. Electronic address: ., Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain., Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain., Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain., Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain; Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain., Servicio de Urología, Hospital Sant'Anna, San Fermo della Battaglia, Como, Italy., Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales y ROC Clinic, Móstoles, Madrid, Spain.