Thulium Laser Enucleation of the Prostate

Anatomical endoscopic enucleation of the prostate (AEEP) is considered a size-independent method for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) according to current international BPO guidelines. AEEP offers less perioperative morbidity compared with traditional transurethral resection of the prostate (TURP) or open prostatectomy while providing comparable long-term durability to open prostatectomy. The thulium fiber laser (TFL) is one prominent energy source for AEEP, which has been widely adopted around the world. We present a step-by-step surgical approach to thulium laser enucleation of the prostate (ThuLEP) using the TFL, describing a modified en-bloc technique for AEEP. In this video, a modified en-bloc technique is presented, performed by one surgeon (C.N.) at our institution. In this example, the outcomes of the en-bloc technique are similar to those of traditional two- or three-lobe techniques. ThuLEP as a treatment for LUTS secondary to BPO results in excellent patient outcomes and can be offered as a treatment of choice for prostates of any size.