World J Urol. 2025 Jul 26;43(1):459. doi: 10.1007/s00345-025-05756-5.
ABSTRACT
PURPOSE: Due to its physical properties, endoscopic enucleation of the prostate (EEP) with the pulsed solid-state Thulium: YAG laser (pulsed ThuLEP) presents a promising alternative to the widely used Holmium: YAG laser (HoLEP). This study aims to compare perioperative parameters of EEP performed using a novel 100 W pulsed Thulium: YAG laser with high peak power versus a standard 100 W Holmium: YAG laser in patients with benign prostatic hyperplasia (BPH).
METHODS: A retrospective analysis was conducted on 312 patients undergoing laser EEP, comprising 80 pulsed ThuLEP and 232 HoLEP procedures. Outcomes were adjusted for key perioperative variables (age, American Society of Anesthesiologists score, hemoglobin, preoperative prostate volume, prostate-specific antigen levels) through multivariable regression analysis. Comparisons between the two techniques utilized adjusted means and marginal contrast analysis.
RESULTS: Baseline characteristics were comparable across groups. Pulsed ThuLEP demonstrated significantly shorter operative times, with a reduction of 6.23 min in total surgery time (p = 0.006) and 4.36 min in enucleation time (p = 0.001) compared to HoLEP. Although pulsed ThuLEP showed faster enucleation speed, it did not reach statistical significance (p = 0.095). Laser energy consumption was comparable (p = 0.191). Additionally, pulsed ThuLEP was associated with reduced hospitalization time (4.19 vs. 4.65 days, p < 0.001) and lower maximum postoperative pain scores (0.78 vs. 4.23, p < 0.001).
CONCLUSION: The novel pulsed solid-state Thulium: YAG laser offers a viable and effective alternative to the established Holmium: YAG laser for EEP. Advantages of pulsed ThuLEP include shorter operative duration, reduced length of hospital stay, and significantly lower postoperative pain, making it a compelling option for surgical management of BPH.
TRIAL REGISTRATION: German Clinical Trials Register number: DRKS00031676.
PMID:40715722 | DOI:10.1007/s00345-025-05756-5
