Efficacy and safety in enucleation of the prostate with thulium fiber laser (TFL) using a 365 μm fiber: a retrospective study in a real-world, risk-diverse population.

purposeTo assess the feasibility of using a 365 μm fiber for Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) in terms of settings, baseline characteristics, patient's peri-operative outcomes and surgeon's feelings.

methodsRetrospective single-center analysis of benign prostatic hyperplasia (BPH) patients that underwent ThuFLEP using a 365 μm fiber over an observation period of 14 months.

resultsAnalysis included 123 patients with mean age 72.4 years old (± 8.9) and average prostate size 94.8 cc (± 51.1); 34.1% of patients were undergoing antiplatelet or anticoagulant treatment before surgical intervention, and 50% maintained their antithrombotic during surgery. All had en-bloc enucleation of the prostate, with mean operation time of 115 min (± 41) and average resected tissue of 67.9 g (± 43). After the procedure, average catheterization time and hospital length of stay were 3 (± 0.9) and 3.6 days (± 1.4), respectively. Early post-operative complications occurred in 23 patients (18.7%). Twenty patients (16.3%) were readmitted to the hospital for check-up (6.5%) or emergency (9.8%), mainly due to catheter removal or macrohematuria respectively. Re-admission rate after one month was 4.9% (n = 6), mainly due to macrohematuria. The surgeon described a very precise and more focused laser beam compared to the 550 μm fiber with excellent instant coagulation during the enucleation.

conclusionThuFLEP using a 365 μm fiber allowed safe and effective enucleation of the prostate regardless of prostate size. While over a third of patients were under antithrombotic/anticoagulant treatment, half underwent surgery on continued medication without a significant increase of risks.