ArticleWorld journal of urology2026
Performance and safety of Thulium fibre laser enucleation of the prostate (ThuFLEP): a comparative study over small, average and large prostate.
Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the safety and efficacy of Thulium Fibre Laser Enucleation of the Prostate (ThuFLEP) in patients with benign prostatic hyperplasia (BPH) across a wide range of prostate volumes, including very large glands (> 150 cc).
methodsWe retrospectively reviewed all consecutive patients who underwent ThuFLEP for drug-refractory or complicated BPH in our department between 2022 and 2024. Patients were stratified into three groups according to preoperative prostate volume: Group 1 (30–80 cc), Group 2 (> 80–150 cc), and Group 3 (> 150 cc). Perioperative outcomes, complications (according to the Clavien–Dindo classification), and functional results at 3 months were compared. Logistic regression was used to identify independent predictors of postoperative complications.
resultsA total of 281 patients were included: 110 (Group 1), 143 (Group 2), and 25 (Group 3). Mean prostate volumes were 64.9 ± 12.7 cc, 105.4 ± 17.1 cc, and 185.0 ± 41.0 cc, respectively. Operative time increased significantly with prostate size (79.1 ± 34.6 min vs. 99.3 ± 43.9 min vs. 133.0 ± 62.3 min; p < 0.01). The overall complication rate was 9.1%, 9.8%, and 40.0% in Groups 1, 2, and 3, respectively (p < 0.01), however, severe complications (Clavien-Dindo > = 3) were not different between the 3 groups. Multivariable analysis identified prostate volume > 150 cc (OR 36.3, 95% CI 4.6–411.5; p < 0.01) and preoperative IPSS (OR 1.2, 95% CI 1.1–1.3; p < 0.01) as independent risk factors for postoperative complications. At 3 months, functional outcomes were similar between groups, with significant IPSS improvement (ΔIPSS = − 10, p = 0.2) and low stress urinary incontinence rates (8.2%, 7.0%, 4.0%; p = 0.2).
conclusionsThuFLEP is a safe and effective surgical option for BPH across all prostate sizes, including very large glands. Although complication rates are higher for prostates > 150 cc, severe complications do not differ compared to smaller prostates and functional outcomes are preserved, supporting ThuFLEP as a feasible minimally invasive alternative for high-volume BPH. Larger multicenter prospective studies are warranted to confirm these findings.
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