Efficacy and safety in enucleation of the prostate with thulium fiber laser (TFL) using a 365 μm fiber: a retrospective study in a real-world, risk-diverse population - Report - MDSpire
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Efficacy and safety in enucleation of the prostate with thulium fiber laser (TFL) using a 365 μm fiber: a retrospective study in a real-world, risk-diverse population
Safety and Effectiveness of ThuFLEP Using 365 μm Fiber in BPH: Retrospective Study
Overview
This retrospective study evaluated the safety and effectiveness of Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) using a 365 μm fiber in 123 patients with benign prostatic hyperplasia (BPH). Results demonstrated feasible operative times, acceptable complication rates, and promising procedural efficiency in a real-world diverse cohort, including patients on antithrombotic therapy.
Background
Benign prostatic hyperplasia (BPH) is commonly treated surgically via techniques such as TURP, open prostatectomy, and anatomical endoscopic enucleation of the prostate (AEEP) using lasers. The Thulium Fiber Laser (TFL) offers precise tissue cutting with minimal thermal damage due to its 1940 nm wavelength and pulsed mode. While larger fibers (550–1000 μm) have been studied, the 365 μm fiber may provide higher energy density and precision, but its clinical outcomes had not been previously reported. This study aimed to assess the feasibility, safety, and initial outcomes of ThuFLEP using the 365 μm fiber in a real-life patient population.
Data Highlights
Parameter
Value (Mean ± SD)
Range
Number of patients
123
53–95 years (age)
Age (years)
72.4 ± 8.9
53–95
Prostate size (g)
94.8 ± 51.1
27–300
Operation time (min)
115 ± 41
59–258
Resected tissue volume (g)
67.9 ± 43
10–250
Total procedure efficiency (g/min)
0.57 ± 0.26
0.11–1.2
Catheterization time (days)
3 ± 0.9
2–8
Hospital length of stay (days)
3.6 ± 1.4
2–8
Peri-operative complications
18.7%
Reoperation rate
10.6%
Early readmission rate
16.3%
Key Findings
Mean operation time was 115 minutes with an average resected prostate volume of 67.9 g.
Total procedure efficiency averaged 0.57 g/min, improving over time and with larger prostate sizes.
Peri-operative complications occurred in 18.7% of patients, mostly bleeding (7.3%) and urinary retention (4.1%).
Reoperation was required in 10.6% of patients, primarily for macrohematuria, with higher incidence in those on antithrombotic therapy and larger prostates.
Early hospital readmission occurred in 16.3% of patients, mostly for catheter removal or emergency reasons.
Use of the 365 μm fiber allowed precise en-bloc enucleation with acceptable safety in a diverse patient cohort including those on anticoagulants.
Clinical Implications
ThuFLEP using a 365 μm fiber is a feasible and effective surgical option for BPH, offering precise tissue cutting and manageable complication rates even in patients on antithrombotic therapy. Surgeons may expect reasonable operative times and procedural efficiency, with careful perioperative management to mitigate bleeding risks. This technique expands laser enucleation options with potential benefits in precision and hemostasis.
Conclusion
The study supports the safety and effectiveness of ThuFLEP with a 365 μm fiber in a real-world BPH population, demonstrating promising procedural efficiency and an acceptable safety profile. Further prospective studies could optimize laser settings and confirm long-term outcomes.
References
Study Source 2024 -- Assessment of the Safety and Effectiveness of Prostate Enucleation Utilizing Thulium Fiber Laser with a 365 μm Fiber
