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

Overview

Journal Prostate Int

Date 2024 Mar 25

PMID 38523902

Authors

Ee Jean Lim

Daniele Castellani

Bhaskar K Somani

Mehmet I Gokce

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

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Materials And Methods: 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.

Results: 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, < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, = 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.

Conclusions: 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.

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