Outcome of Thulium Fiber Laser Enucleation of Prostate in the Learning Curve: An Observational Study

Abstract

Introduction
Benign enlargement of the prostate (BEP) is the most common disease among aging males requiring surgical interventions. Laser enucleations are the most recent advances. This study aims to find the success and complications of Thulium fiber laser enucleation of prostate (ThuFLEP).

Methods
Hospital based prospective descriptive study conducted from December 2022 to May 2023 in the Department of Urology of Birat Medical College Teaching Hospital. We included initial 30 cases according to our inclusion criteria. Patient’s age, prostate volume, International Prostate Symptom Score (IPSS), Prostate Specific Antigen (PSA), Pre and postoperative hemoglobin, post procedure urinary flow rate was calculated, and any complication/s were recorded.

Results
The initial 30 cases that underwent ThuFLEP were included. The mean age, prostate volume, IPSS, PSA, pre and post operative Hb and urinary flow rate after catheter removal were 69.97 ± 10.78 years, 67.03±11.03 gms, 26.27±4.22, 1.53±0.53 ng/ml, 12.50±1.33 gm/dl, 12.12±1.35 gm/dl and 21.73±2.07 ml/s were respectively. The mean operating time and hospital stay was 71.47±12.07minutes and 3±00 days respectively. There was significant changes in IPSS (26.27±4.22 vs 5.70±2.09) following the procedure (p<0.001). Complications occurred in two patients (6.67%) as morcellation associated bladder mucosal injury which resolved on conservative management.

Conclusion
The ThuFLEP appears to be a feasible minimally invasive option for selected patients with benign prostatic enlargement. Larger prospective studies with longer follow-up are needed before definitive conclusions regarding efficacy, durability, and learning curve can be made.