Introduction: Thulium laser prostate enucleation (ThuLEP) has become a novel treatment option for BOO. Most studies evaluated the safety and efficacy of high-power thulium enucleation using 120-200 W. we evaluated the use of low-power thulium (30 W) as regard efficacy and time needed to remove the adenoma at the level of the surgical capsule and postoperative urinary and sexual functions.
Methods: Patients with symptomatic BPH who failed medical treatment or developed BPH- related complications with prostate size larger than 80 ml and candidates for ThuLEP during the period from December 2019 to June 2021 were included. We used a 30 W Thulium laser with a 550µm laser fiber and a 26 Fr continuous flow resectoscope. Data collected included prostate size, PSA, enucleation and morcellation time, postoperative IPPS, & IEFF-5 scores at one week, 1, 3 & 6 months.
Results: Thirty-seven patients underwent ThuLEP with a mean age of 68 ± 6. Refractory retention was the main indication for surgery in 21.6% of patients, hematuria in 8% & failed medical treatment in 70%.3 with a mean IPPS score of 25.6 ± 2.2. The mean prostate size was 111 ± 20 ml and the mean Qmax was 6.8 ± 2 ml/sec. The mean enucleation time was 70 ± 10 min, and the mean morcellation time was 24 ± 6 min. The mean reduction in PSA level after 6 months was 3.4 ± 1.1 & the mean hemoglobin drop was 1.7 ± 0.6 mg/dl. The 1st follow-up visit was at one week with a mean IPSS 8.3 ± 1.9, mean Qmax improvement of 26 ± 4.6 ml/s. Our results showed significant improvement in postoperative urgency and UUI (p-value= 0.005) with no significant change in IIEF-5 score at 6-month follow-up compared to baseline.
Conclusions: Low–power ThuLEP is an efficient technique for prostate enucleation with less escharing effects and satisfactory urinary and sexual outcomes.
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