Novel Thulium Fiber Laser for Enucleation of Prostate: A Retrospective Comparison with Open Simple Prostatectomy

Introduction: The objective of this study was to assess the efficacy and safety of novel thulium fiber laser enucleation of the prostate (ThuFLEP) vs conventional open simple retropubic prostatectomy (OP) for large volume benign prostatic hyperplasia (BPH). Methods: We performed a retrospective review of patients who underwent surgical treatment for large volume BPH (>80 cc) from 2015 to 2017. Preoperative patient examination included the assessment of functional parameters: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Q(max)), and postvoid residual urine volume. The hemoglobin level was measured before and after the operation. Results: A total of 130 patients were included in the study. Of these, 40 patients underwent OP, and 90 patients underwent ThuFLEP. Groups were similar in terms of preoperative functional parameters (IPSS, QoL, and Q(max)). The mean operative time was comparable for both procedures (p=0.285) as well as the mass of adenomatous tissue resected (p=0.412). Resection speed was comparable (OP0.9 vs ThuFLEP1.0g/min, p=0.52). Patients in OP had significantly longer catheterization time and length of hospital stay (9.0 days vs 3.3 days, p<0.001). At 6 months, stress urinary incontinence rate were 1.1% after ThuFLEP and 2.5% after OP. Conclusions: Despite the equally high efficacy of both modalities for infravesical obstruction due to BPH, ThuFLEP is a minimally invasive modality that is associated with a shorter hospital stay, a significantly greater return to normal activities, and a considerable reduction in rehabilitation time. Our results demonstrated that the ThuFLEP is a highly efficacious, minimally invasive modality for the management of BPH in large volume glands (>80 cc).