High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group.

Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power holmium laser (HPHL) in hands of experienced surgeons for large prostates (≥80 ml in volume). Secondary outcomes were assess complications within 1 year of follow up.

We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centers (January 2019-January 2023). Patients with prostate volume ≥80 ml were included, while those with concomitant prostate cancer, previous prostate/urethral surgery, and pelvic radiotherapy were excluded.

Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470. After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed. Overall operative time (90 [70, 120] vs. 52.5 [39, 93] min, P < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, P = 0.914). In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis. In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation.

This real-world study reaffirms that HPHL and TFL in large prostates are equally efficacious in terms of 30-day complications. TFL with the en-bloc technique has a shorter operative time which significantly improves short- and medium-term functional outcomes.

Prostate international. 2023 Dec 13 [Epub]

Ee Jean Lim, Daniele Castellani, Bhaskar K Somani, Mehmet I Gökce, Khi Yung Fong, Fernando G Sancha, Thomas R W Herrmann, Sarvajit Biligere, Azimdjon N Tursunkulov, Marco Dellabella, Mario Sofer, Dmitry Enikeev, Vladislav Petov, Nariman Gadzhiev, Dean Elterman, Abhay Mahajan, Moises R Socarras, Dilmurod S Yunusov, Furkat Nasirov, Jeremy Y C Teoh, Vineet Gauhar

Department of Urology, Singapore General Hospital, Singapore., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, Ankara University, School of Medicine, Ankara, Turkey., Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain., Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland., Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore., Urology Division, Akfa Medline Hospital, Tashkent, Uzbekistan., Urology Unit, IRCCS INRCA, Ancona, Italy., Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia., 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., Urology Department, Tashkent Medical Academy, Uzbekistan., S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.