Thulium fiber laser enucleation of the prostate (ThuFLEP) for the treatment of benign prostatic obstruction: a comparative study of men with prostate volumes ≥ 150 mL and < 150 mL.

purposeWe aimed to evaluate the outcomes of Thulium fiber laser enucleation of the prostate (ThuFLEP) in men with prostate volumes (PV) ≥ 150 mL and to compare them with those with PV < 150 mL.

methodsWe retrospectively analyzed the patients who underwent ThuFLEP between December 2020 and June 2024 for benign prostatic obstruction (BPO). Patients were categorized into two groups according to prostate volume, with Group 1 including those with PV < 150 mL (n = 355) and Group 2 including those with PV ≥ 150 mL (n = 147). Perioperative and postoperative functional outcomes, as well as complications, were evaluated and compared.

resultsBoth groups demonstrated significant improvements in functional parameters (International Prostate Symptom Score-IPSS, maximal urinary flow rate-Qmax and postvoid residual urine volume-PVR) compared with baseline values at the 1, 6 and 12 months postoperatively. Postoperative IPSS, QoL scores, Qmax, PVR values, and rates of urge urinary incontinence (UUI) and stress urinary incontinence (SUI) were comparable between groups at all follow-up intervals (p > 0.05). No patient exhibited postoperative SUI or UUI at 6 and 12 months postoperatively. Complication rates were similar between groups, and no Grade ≥ 4 Clavien-Dindo complications occurred.

conclusionThuFLEP is a safe and effective LEP technique for very large prostates (≥ 150 mL). It yields significant improvements in postoperative functional outcomes with low perioperative complication rates, supporting its use as a minimally invasive alternative for BPO in routine endourology practice.