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Thulium: YAG vs continuous-wave thulium fiber laser enucleation of the prostate: do potential advantages of thulium fiber lasers translate into relevant clinical differences?

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Abstract

Purpose

To compare endoscopic enucleation of the prostate using a thulium: yttrium–aluminum–garnet (Tm:YAG) laser and a super-pulsed thulium fiber laser set in continuous-wave (CW) mode, and to evaluate whether theoretical advantages of thulium fiber lasers, related to their shorter wavelength, translate into relevant clinical differences.

Methods

In total, 110 patients suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia were randomized to undergo either thulium:YAG laser enucleation of the prostate (ThuLEP) or CW thulium fiber laser enucleation of the prostate (CW-ThuFLEP). Intraoperative and postoperative variables and complications were compared. Micturition improvement was assessed at 3-month follow-up using the International Prostate Symptom Score (IPSS), post-void residual urine (PVR) and maximum flow rate (Qmax). Erectile function was evaluated using the International Index of Erectile Function-5 (IIEF-5).

Results

No significant differences between the ThuLEP and CW-ThuFLEP groups were found in terms of operative time (70.69 vs 72.41 min), enucleation time (50.23 vs 53.33 min), enucleated tissue weight (40.2 vs 41.9 g), enucleation efficiency (0.80 vs 0.79 g/min), catheterization time (2.45 vs 2.57 days), hospital stay (2.82 vs 2.95 days) and hemoglobin drop (1.05 vs 1.27 g/dl). At 3-month follow-up, no significant differences were found in IPSS (5.09 vs 5.81), Qmax (26.51 vs 27.13 ml/s), PVR (25.22 vs 23.81 ml) and IIEF-5 (14.01 vs 14.54).

Conclusion

ThuLEP and CW-ThuFLEP were equivalent in relieving patients from LUTS and improving micturition. Theoretical advantages of the TFL, such as shallower penetration depth and improved vaporization capacity, did not translate into relevant perioperative outcomes or clinical differences.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

The authors declare that no extra institutional funding was received.

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Authors and Affiliations

  1. Department of Urology, ASST-Lariana, Ospedale Sant’Anna, San Fermo della Battaglia, CO, Italy

    Giorgio Bozzini, Andrea Pacchetti, Davide Perri, Elena Morini & Federica Mazzoleni

  2. Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy

    Lorenzo Berti, Matteo Maltagliati, Umberto Besana, Giovanni Saredi & Carlo Buizza

  3. Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy

    Lorenzo Berti, Matteo Maltagliati & Salvatore Micali

  4. Department of Urology, Clinique Saint Augustin, Bordeaux, France

    Jean Baptiste Roche

  5. Department of Urology, Hospital Universitario, 12 de Octubre, Madrid, Spain

    Javier Romero-Otero

  6. Department of Urology, ASST-Santi Paolo e Carlo, Milan, MI, Italy

    Maria Chiara Sighinolfi & Bernardo Rocco

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  1. Giorgio Bozzini
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Contributions

BG, BL, MM, BU, MS, SG, RJB, R-OJ and BC, RB developed protocol/project. PA, PD, ME, MF and SMC collected or managed the data. PA, PD, ME, MF and SMC analyzed the data. BG, BL and MM wrote/edited the manuscript. BG, BU, MS, SG, RJB, R-OJ, BC and RB were involved in supervision.

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Correspondence to Giorgio Bozzini.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by our local ethical committee.

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Bozzini, G., Berti, L., Maltagliati, M. et al. Thulium: YAG vs continuous-wave thulium fiber laser enucleation of the prostate: do potential advantages of thulium fiber lasers translate into relevant clinical differences?. World J Urol 41, 143–150 (2023). https://doi.org/10.1007/s00345-022-04201-1

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