Thulium Fiber Laser Enucleation of the Prostate: Prospective Study of Mid- and Long-Term Outcomes in 1328 Patients

The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). We analyzed patients who underwent ThuFLEP due to lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, postvoid residual (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen level, and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization, and data on hospital stays were also collected. A subgroup analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. A total of 1328 patients were included in the analysis. The mean age was 66.9 ± 7.5 years. Mean prostate volume was 86.9 ± 41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p < 0.05) and showed durable improvement up to 3 years of follow-up. The frequency of late complications was as follows: stress urinary incontinence-1.2%; urethral stricture-1.1%; and bladder neck contracture-0.9%. Subgroup analyses revealed increased urinary tract infection frequency in older patients (3.5% vs 0.8%, p = 0.003) as well as higher rate of stress urinary incontinence (0.4% vs 1.8%, p = 0.002) and higher rate of clot retention (11.3% vs 4.4%, p < 0.001) in those with larger glands. Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be a promising alternative to holmium laser enucleation of the prostate for treatment of LUTS associated with BPO.