Evaluating the pulsed solid-state Thulium: YAG laser in men with benign prostatic hyperplasia in a real-world setting

This study evaluated the real-world experiences of patients treated with endoscopic enucleation of the prostate (EEP) with the solid-state Thulium laser system (Thulio) for benign prostatic hyperplasia (BPH) treatment. The studies concluded that Thulium laser EEP was a safe and effective treatment option for these patients.

Benign prostate hyperplasia (BPH) refers to an enlarged, non-cancerous prostate gland. BPH is a common disease and its occurrence increases with age. In some patients, an enlarged prostate can press against the bladder causing lower urinary tract symptoms (LUTS). These include urination problems. The first treatment option usually involves medications that relax the neck of the bladder. Patients who do not benefit from medications are traditionally treated with transurethral resection of the prostate (TURP). This is a surgical procedure that requires the removal of prostate tissue through the urethra (the tube that passes urine through the penis). Surgical procedures are associated with higher risks such as bleeding.

Laser-based procedures have been developed over the years as safer alternatives compared to traditional surgical procedures. One of these laser-based alternatives is the Holmium laser enucleation of the prostate (HoLEP). However, this method can be associated with bleeding complications. A newer laser type, the solid-state continuous Thulium laser (Tm: YAG), was recently designed. However, currently, the pulsed Tm: YAG laser has been evaluated mostly in experimental studies. It is important to evaluate the effectiveness and safety of this novel solid-state Tm: YAG (Thulio) laser in humans. This is the first clinical study to evaluate the effectiveness and safety of a new surgical procedure called endoscopic enucleation of the prostate (EEP) for the treatment of benign prostatic hyperplasia (BPH).

This study included a total of 103 patients with BPH that did not respond to medications. All men underwent enucleation of the prostate using the solid-state Thulium: YAG laser system (Thulio). Patients were followed up after 15 months. 

20.4% of patients experienced short-term mild complications after the procedure. 4.9% of patients had blood in their urine and needed another procedure. 10.7% of patients developed short-term urinary retention after catheter removal. The average hospital stay was 4 days and the average period to hold a catheter was 2 days.

After 15 months, 96.1% of patients were satisfied with the procedure. 54% of patients had an improvement in continence (the ability to hold urine in the bladder), while 7.9% reported a worsening in continence. 64.9% of patients still needed to urinate during the night (nocturia). 93.4% of patients had an improvement in urine stream. 81.6% of patients had no differences in sexual function, while 7.9% reported an improvement and 9.2% reported worse sexual function.

This study concluded that the Thulium laser enucleation of the prostate was a safe and effective treatment option for BPH in a real-world setting.

The study looked back at what happened to patients who had been treated in the past. All patients came from the same German medical center. Larger studies are needed in comparison with other laser procedures.