Comparison of HoLEP, ThuLEP and ThuFLEP in the Treatment of Benign Prostatic Obstruction: a Propensity Score-matched Analysis

Overview

Journal World J Urol

Specialty Urology

Date 2024 Jun 13

PMID 38871959

Authors

Halil Cagri Aybal

Mehmet Yilmaz

Irfan Safak Barlas

Mehmet Duvarci

Altug Tuncel

Lutfi Tunc

Affiliations

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Abstract

Purpose: To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM).

Methods: We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared.

Results: We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications.

Conclusion: HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.

Citing Articles

The Impact of Transurethral Enucleation Therapeutic Approach in All-Size Benign Prostatic Obstruction Pathology: From Contemporary Technological Advances to Evidence-Based Clinical Progresses.

Bulai C, Multescu R, Geavlete P, Punga A, Militaru A, Buzescu B Diagnostics (Basel). 2025; 15(4).

PMID: 40002567 PMC: 11854753. DOI: 10.3390/diagnostics15040416.

Exploring the optimal parameter settings of a thulium fiber laser during soft tissue resection.

Li Z, Wu S, Tang X, Zuo Y, Liu T, Wang D Lasers Med Sci. 2025; 40(1):118.

PMID: 39998717 DOI: 10.1007/s10103-025-04375-1.

HoLEP versus ThuFLEP in men with very large prostates (> 175 ml).

Aybal H, Yilmaz M, Barlas I, Duvarci M, Guven S, Tunc L World J Urol. 2025; 43(1):109.

PMID: 39918564 DOI: 10.1007/s00345-025-05478-8.

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