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 las...

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Published in:Prostate international 2024-03, Vol.12 (1), p.40-45
Main Authors: Lim, Ee Jean, Castellani, Daniele, Somani, Bhaskar K., Gökce, Mehmet I., Fong, Khi Yung, Sancha, Fernando G., Herrmann, Thomas R.W., Biligere, Sarvajit, Tursunkulov, Azimdjon N., Dellabella, Marco, Sofer, Mario, Enikeev, Dmitry, Petov, Vladislav, Gadzhiev, Nariman, Elterman, Dean, Mahajan, Abhay, Socarras, Moises R., Yunusov, Dilmurod S., Nasirov, Furkat, Teoh, Jeremy Y.C., Gauhar, Vineet
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Language:English
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Endoscopic enucleation of the prostate
Laser therapy
Postoperative complications
Prostatic hyperplasia
Urinary incontinence
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container_title Prostate international
container_volume 12
creator Lim, Ee Jean
Castellani, Daniele
Somani, Bhaskar K.
Gökce, Mehmet I.
Fong, Khi Yung
Sancha, Fernando G.
Herrmann, Thomas R.W.
Biligere, Sarvajit
Tursunkulov, Azimdjon N.
Dellabella, Marco
Sofer, Mario
Enikeev, Dmitry
Petov, Vladislav
Gadzhiev, Nariman
Elterman, Dean
Mahajan, Abhay
Socarras, Moises R.
Yunusov, Dilmurod S.
Nasirov, Furkat
Teoh, Jeremy Y.C.
Gauhar, Vineet
description 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 
doi_str_mv 10.1016/j.prnil.2023.12.001
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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 &lt; 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P &lt; 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. 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subjects Endoscopic enucleation of the prostate
Laser therapy
Postoperative complications
Prostatic hyperplasia
Urinary incontinence
title 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
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