Introduction and Objectives

Benign prostatic hyperplasia (BPH) is a common condition in men where the prostate enlarges and can lead to lower urinary tract symptoms. A procedure called laser enucleation of the prostate is a modern treatment that reduces urinary obstruction by resecting a significant portion of the prostate. The study aims to compare the safety profile and clinical outcomes of Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP).

Methods

61 patients aged from 54 to 90 years with BPH underwent HoLEP (n=30) or ThuLEP (n=31) procedures in a prospective, non-randomized, multicenter study between September 2021 to December 2023. Two surgeons experienced with HoLEP and ThuLEP performed all procedures in two centers. Follow-up was assessed at 3 months after surgery. The primary endpoints were non-inferior international prostate symptom score (IPSS) and quality of life (QoL) at 3 months. Secondary endpoints were rate of post-operative complications, peak flow (Qmax), post-void residual (PVR), international index of erectile function (IIEF), international consultation on incontinence questionnaire-short form (ICIQ-SF) and operation, catheterization, hospitalization times. 

Results

Mean operative time was 127 min and 100.17 min in the HoLEP group and the ThuLEP group respectively (p=0.70). Weight of specimen post-operatively was comparable (96.32 cc versus 92.35 cc, p=0.75). At 3 months, there were no statistically significant differences between the HoLEP group and the ThuLEP group regarding IPSS (6.25 versus 5.42, p=0.52), QoL (1.21 versus 1.27, p=0.88), IIEF (10.05 versus 13.23, p=0.27) and ICIQ-SF (5.65 versus 5.65, p>0.9). In addition, uroflowmetry was comparable with no statistically significant differences regarding Qmax (18.13 mL/s versus 14.52 mL/s, p=0.16) and PVR (26.80 mL versus 30.60 mL, p=0.79). Among the HoLEP arm, 84% of the patients had a catheterization duration lower than 24h, whereas 80% of the patients in the ThuLEP arm had a catheterization duration between 24h and 48h. Mean hospitalization time was 17.52 hours in the HoLEP group and 12.08 hours in the ThuLEP group (p=0.15). Complications rate was 13% (n=4) and 3% (n=1) in the HoLEP group and ThuLEP group respectively. One patient required a transfusion in the HoLEP arm. 

Conclusion

Both ThuLEP and HoLEP relieve lower urinary tract symptoms with comparable results in terms of functional outcome.