The use of the new thulium fiber laser in enucleation of the prostate (ThuFLEP) has been introduced recently.
To evaluate complications and urinary incontinence (UI) after ThuFLEP in small and large prostate volume (PV).
We retrospectively reviewed patients who underwent ThuFLEP in six centers (from January 2020 to January 2023). The exclusion criteria were concomitant lower urinary tract surgery, previous prostate/urethral surgery, prostate cancer, and pelvic radiotherapy.
Patients were divided into two groups: group 1: PV ≤80 ml; group 2: PV >80 ml. Univariable and multivariable logistic regression analyses were performed to evaluate the independent predictors of overall UI.
There were 1458 patients in group 1 and 1274 in group 2. There was no significant difference in age. The median PV was 60 (61-72) ml in group 1 and 100 (90-122) ml in group 2. En bloc enucleation was employed more in group 1, while the early apical release technique was used more in group 2. The rate of prolonged irrigation for hematuria, urinary tract infection, and acute urinary retention did not differ significantly. Blood transfusion rate was significantly higher in group 2 (0.5% vs 2.0%, p = 0.001). There was no significant difference in the overall UI rate (12.3% in group 1 vs 14.7% in group 2, p = 0.08). A multivariable regression analysis showed that preoperative postvoiding urine residual (odds ratio 1.004, 95% confidence interval 1.002-1.007, p < 0.01) was the only factor significantly associated with higher odds of UI. A limitation of this study was its retrospective nature.
Complications and UI rates following ThuFLEP were similar in patients with a PV up to or larger than 80 ml except for the blood transfusion rate that was higher in the latter.
In this study, we looked at outcomes after thulium fiber laser in enucleation of the prostate stratified by PV. We found that blood transfusion was higher in men with PV >80 ml, but urinary incontinence was similar.
European urology open science. 2024 Mar 21*** epublish ***
Daniele Castellani, Dmitry Enikeev, Mehmet Ilker Gokce, Vladislav Petov, Nariman Gadzhiev, Abhay Mahajan, Pankaj Nandkishore Maheshwari, Khi Yung Fong, Azimdjon N Tursunkulov, Vigen Malkhasyan, Marek Zawadzki, Mario Sofer, Luigi Cormio, Gian Maria Busetto, Bhaskar Kumar Somani, Thomas R W Herrmann, Vineet Gauhar
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation., Department of Urology, Ankara University School of Medicine, Ankara, Turkey., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia., Sai Urology Hospital and Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India., Urology Unit, Fortis Hospital Mulund, Mumbai, India., Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan., Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation., Urology Unit, St. Anna Hospital, Piaseczno, Poland., Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Andrology and Urology Unit, Bonomo Teaching Hospital, Andria, Italy., Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK., Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.