Thulium fiber laser enucleation of the prostate with SOLTIVE™ SuperPulsed laser systems: a prospective evaluation of early outcomes in an Asian cohort.

Introduction: Thulium fiber laser (TFL) technology, with its shorter wavelength and higher water absorption coefficient compared to Holmium: YAG laser, offers theoretical advantages in tissue ablation efficiency and safety profile. We aim to evaluate the early safety and feasibility of Thulium fiber laser enucleation of prostate (ThuFLEP) using the SOLTIVE™ SuperPulsed Laser Systems in the first Asian cohort. Methods: Thirty-two consecutive men underwent ThuFLEP between October 2022 and September 2025. The primary outcome was the rate of Clavien-Dindo grade ≥3 complications as a safety and feasibility signal, along with assessment of short-to-medium-term functional outcomes. Data are presented as median (interquartile range, IQR). Changes in PSA were analyzed using the Wilcoxon signed-rank test. Results: The median prostate size was 60 ml (IQR 49.8-76.0 ml), with 50% of patients being catheter dependent. Median operation time was 87 minutes (IQR 73-100 mins). Median enucleated adenoma weight was 31 g (IQR 20-39 g). No Clavien-Dindo grade ≥3 complications occurred. Catheter-free rate was 87.5% on day 1 and 100% by day 14. At 3-month follow-up, median IPSS was 4 (IQR 1-8), median Qmax was 21.5 ml/s (IQR 12.9-28.4 ml/s), with significant PSA reduction (from 6.05 to 1.20 ng/ml; p<0.001). At 12 months (n=25), median Qmax was 21.9 ml/s (IQR 15.2-26.8 ml/s), median IPSS was 2 (IQR 1-5), and there was no surgical or medical retreatment. Conclusion: ThuFLEP demonstrates early safety and feasibility in this Asian cohort, including catheter-dependent patients. Larger, multicenter studies with longer follow-up are warranted to confirm its safety and efficacy. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05292235.