Initial experience of endoscopic thulium fiber laser enucleation of the prostate: perioperative outcomes and learning curve.

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Holmium enucleation of the prostate is currently the treatment of choice for the management of complicated or drug-unresponsive lower urinary tract symptoms due to benign prostate hyperplasia(BPH). Thulium Fiber Laser(TFL) is an alternative to holmium laser and seems to be safe and effective. We aimed to report our initial experience with TFL. We included each consecutive patient who underwent TFL enucleation of the prostate (THUFLEP) in a single academic center using the TFL drive laser generator (Coloplast ©) with a 550um fiber. Surgery was performed by 3 surgeons who did not have any experience in prostate enucleation. Perioperative outcomes were collected prospectively, such as functional 3-month follow-up. Pentafecta was used to assess the optimal outcomes of THUFLEP. Preoperative and postoperative IPSS and QoL were also compared. Overall, we included 71 patients with a mean age of 69.4 years (SD 11.6) and a mean prostate volume of 90.2cc (SD 30.5). The mean operative time was 120.9 minutes (SD 49.3), with a mean enucleation time of 85.1 minutes(SD 37.5) and a mean morcellation time of 18.3 minutes (SD 15.6). The mean length of stay was 1.8 days(SD 2.1) and 11 patients (15.5%) had a postoperative complication. Catheter removal failure occurred in 3 patients (4.2%), but at 3 months no patients had a catheter. IPSS and QoL at 3 months were significantly improved compared with before surgery(p<0.001). Three patients reported stress urinary incontinence (4.2%). Pentafecta was achieved for 29 patients (40.8%). This study confirms the safety and efficacy of THUFLEP. The procedure was associated with low postoperative complication rates and satisfactory short-term functional outcomes.