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 - Scorecard - 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
Clinical Scorecard: Assessment of the Safety and Effectiveness of Prostate Enucleation Utilizing Thulium Fiber Laser with a 365 μm Fiber: A Retrospective Analysis in a Diverse Real-World Cohort
At a Glance
Category
Detail
Condition
Benign prostatic hyperplasia (BPH)
Key Mechanisms
Thulium Fiber Laser (TFL) at 1940 nm wavelength with pulsed and continuous-wave modes enabling precise tissue cutting with minimal carbonization and maximal hemostasis
Target Population
Men with BPH, including those with large prostate size, on anticoagulant or antiplatelet therapy, and without prior prostate cancer or hematological disease
Care Setting
Single-center hospital setting performing ThuFLEP with 365 μm fiber laser
Key Highlights
Use of a smaller 365 μm fiber allows precise knife-like cutting with higher energy density and minimal parenchymal burning
Mean operation time was 115 minutes with average resected prostate volume of 67.9 g and procedure efficiency of 0.57 g/min
Peri-operative complications occurred in 18.7% of patients, mostly bleeding and urinary retention; reoperation rate was 10.6%, often associated with anticoagulant/antiplatelet use and larger prostate size
Guideline-Based Recommendations
Diagnosis
Patient selection excludes prior prostate cancer or hematological disease
No age, anticoagulant treatment, or prostate size restrictions for ThuFLEP
Management
Use TFL settings of 1.2 J, 30 Hz (36 W) short pulse for enucleation and 0.6 J, 40 Hz (24 W) long pulse for coagulation with 365 μm fiber
Maintain or pause antithrombotic therapy based on clinical judgment; some patients continued therapy during surgery
Perform en-bloc enucleation followed by morcellation using appropriate morcellator
Monitoring & Follow-up
Assess peri-operative complications using Clavien-Dindo classification
Monitor catheterization time (~3 days) and hospital length of stay (~3.6 days)
Follow-up for early readmission within 30 days for catheter removal or emergency reasons
Risks
Increased bleeding risk especially in patients on antithrombotic therapy
Urinary retention risk associated with ongoing antiplatelet therapy
Higher complication and reoperation rates in patients with larger prostate volumes (>85 g)
Patient & Prescribing Data
123 BPH patients aged 53–95 years, including 34.1% on antithrombotic therapy and 42.3% with preoperative indwelling catheter
Surgical efficiency improved over time and with larger prostate size; perioperative management of antithrombotic therapy varied with some patients continuing treatment during surgery
Clinical Best Practices
Utilize 365 μm fiber TFL with specified energy and frequency settings for precise enucleation and effective coagulation
Carefully evaluate and manage antithrombotic therapy perioperatively to balance bleeding risk and thrombotic risk
Monitor patients closely postoperatively for bleeding, urinary retention, and need for reoperation
Consider prostate size in surgical planning as larger prostates may increase procedure efficiency but also complication risk
