MP29-19: Prospective randomized trial assessing the severity of irritative symptoms after holmium laser enucleation of the prostate (HoLEP) versus thulium fiber laser enucleation of the prostate (ThuFLEP).

Dmitry Enikeev*, Mark Taratkin, Diana Babaevskaya, Vladislav Petov, Mikhail Enikeev, Roman Sukhanov, Evgeny Shpot, Denis Chinenov, Moscow, Russian Federation, Thomas Herrmann, Hannover, Germany

Introduction: Endoscopic enucleation of the prostate (EEP) is considered one of the primary treatment options for BPH. A recently introduced thulium fiber laser (TFL) has the potential to minimize the thermal-related side effects on the peripheral zone and adjacent structure (such as sphincter and neurovascular bundle) due to its decreased penetration depth (0.15 mm in TFL versus 0.4 - 0.7mm in Ho:YAG). The aim of this study is to compare the short-, mid-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP).

Methods: This prospective randomized simple-blinded study was performed in accordance with CONSORT. The inclusion criteria were moderate-to-severe LUTS (defined as IPSS >20 or Qmax <10 ml/s). Patients were randomized between HoLEP (VersaPulse 100 W, Lumenis, Israel) and ThuFLEP (TFL U3, IRE-Polus, Russia). Preoperatively, demographics, objective data (PSA, prostate volume, etc.) and data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information was collected as well as postoperative data on urinary incontinence and functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months.

Results: Data on 163 participants were included (77 – HoLEP, 86 - ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn’t differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p>0.05). The mean values of QUID for HoLEP and ThuFLEP were respectively: 13.4±4.9 and 13.1±5.0 1 week after surgery, 10.5±4.4 and 10.3±4.2 one month after surgery, 7.2±2.2 and 7.3±2.3 6 month after surgery. There was a significant increase in total ICIQ-MLUTS, bother and voiding scores at 1 and 3 months compared with the baseline in both groups (p < 0.05). Yet, no difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.4% and 2.3% respectively.

Conclusions: Both ThuFLEP and HoLEP are comparable in terms of duration and postoperative complication rates. The results of the study showed no apparent differences in the rate of SUI and irritative symptoms.

Source of Funding: None