Evaluating the short-term functional outcomes and safety of holmium and thulium fiber laser enucleation of the prostate treatment for patients with benign prostatic hyperplasia.

This study evaluated the short-term functional outcomes and safety of holmium (HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) treatment for patients with benign prostatic hyperplasia (BPH). The data showed that both HoLEP and ThuFLEP surgeries are similar in terms of functional outcomes and safety in these patients.  

BPH is the non-cancerous increase in the size of the prostate gland. BPH can cause lower urinary tract symptoms (LUTS) such as frequent urination, trouble starting to urinate, and a weak stream while urinating. Other symptoms include urine leakage (incontinence) and discomfort passing urine. LUTS/BPH can lead to problems relating to the quality of life and mental health issues. Sexual function can also be negatively impacted.

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure to treat BPH. HoLEP allows for the destruction of prostate tissue blocking urine flow with a laser inserted into the urethra (the penis opening). HoLEP is generally well-tolerated and associated with relatively few complications.

Studies have shown that newer laser technologies like ThuFLEP may be associated with better functional outcomes. ThuFLEP is the use of a more powerful laser to remove excess prostate tissue through the urethra. It is thought that ThuFLEP is a more powerful technology that may reduce the risk of complications compared to HoLEP. However, a direct comparison of the short-term functional outcomes and safety of HoLEP versus ThuFLEP for the treatment of patients with BPH is lacking.

This study involved 163 patients with BPH. 77 men received treatment with HoLEP. 86 men received treatment with ThuFLEP. The urinary and sexual functions were measured by patient-reported questionnaires. These questionnaires measured the symptoms of LUTS, quality of life (QoL), erectile function, maximum urine flow rate, and the volume of urine left in the bladder after urination. Patients were followed up 6 months after the procedure.

No differences were found in the duration of surgery, the number of complications after surgery, the time until the removal of the urinary catheter, and the length of hospital stay.

There was no difference in terms of the symptoms of LUTS, QoL, erectile function, maximum urine flow rate, and the volume of urine left in the bladder after urination between the two groups.

After 3 months, 1.3% of patients in the HoLEP group experience stress urinary incontinence (SUI; urine leakage due to physical activity, sneezing, or laughing) compared to 3.5% in the ThuFLEP group. After 6 months, 1.3% of patients in the HoLEP group had SUI compared to 2.3% in the ThuFLEP group.  

This study concluded that both HoLEP and ThuFLEP surgeries are similar in terms of functional outcomes and safety in patients with BPH.  

The side effects were measured by patient-reported questionnaires which could affect the conclusions. This study only included 5 surgeons and the personal experience of each surgeon could influence the outcomes.