HoLEP versus ThuFLEP: perioperative and functional outcomes in prostate enucleation

Abstract

Objective To compare the outcomes of laser enucleation techniques by evaluating the postoperative data of patients with benign prostate obstruction (BPO) undergoing ThuFLEP and HoLEP. Methods This retrospective study included men > 50 years with LUTS due to BPO who underwent HoLEP or ThuFLEP by a single experienced surgeon between January 2023 and January 2024. Patients were also stratified into subgroups according to prostate size (< 80 g vs. ≥ 80 g). The primary outcome was to compare success rate, operative duration, and efficiency of HoLEP and ThuFLEP; secondary outcomes included safety profile, catheter removal time, and long-term complications (stress urinary incontinence and stricture). Results A total of 163 patients (HoLEP: n = 94, ThuFLEP: n = 69) were included. Median operation time was longer in ThuFLEP (100 vs. 90 min, p = 0.001). Enucleation ratio, surgical efficiency, haemoglobin drop, ∆PVR, ∆Qmax, and ∆QoL were similar. IPSS improvement was greater in ThuFLEP (15 vs. 10 points, p = 0.023). In prostates > 80 g, ThuFLEP had longer operation and hospitalization times, but other perioperative and functional outcomes were comparable. Complication rates, catheterization time, and discharge duration were similar in all groups. Conclusions Both HoLEP and ThuFLEP are safe and effective for BPH treatment. ThuFLEP shows slightly longer operative time, especially in larger prostates, while functional improvements and complication rates are comparable.