Long-term outcomes of thulium fiber laser enucleation of the prostate (ThuFLEP): five-year follow-up

Background.  Thulium fiber laser enucleation (ThuFLEP) is a promising method for the treatment of benign prostatic    Objective.  To evaluate the long-term efficacy and safety of ThuFLEP.    Materials and Methods.  This retrospective study included patients who underwent ThuFLEP in 2018–2019. The inclusion criteria were severe lower urinary tract symptoms (IPSS > 20 points) and/or Qmax < 15 mL/s, or the presence of an indwelling catheter. The procedure was performed using FIBERLASE U1 (NTO “IRE-Polus”, Russia). We assessed changes in IPSS, maximum urinary flow rate (Qmax), prostate volume, postvoid residual urine volume, PSA level, and the incidence of late complications, reoperations, and additional procedures.    Results.  A total of 115 patients were included, with a median follow-up of 72 (66; 78) months. Five years after ThuFLEP, prostate volume decreased from 103 to 24 cm 3  (p < 0.001), Qmax increased from 6.3 to 18.9 mL/s (p < 0.001), and the total IPSS score decreased from 20 to 8 points (p < 0.001). Postvoid residual urine volume (from 50 to 30 mL) and quality of life (QoL) score (from 5 to 2 points) also improved significantly (p < 0.001). Late complications were observed in 10 (8.7 %) patients: urethral stricture in 2 (1.7 %) and persistent stress urinary incontinence in 1 (0.8 %) patient. Reoperations for recurrent BPH were performed in 2 (1.7 %) patients, and additional procedures in 8 (6.9 %) patients. Medical therapy was resumed in 9 (7.8 %) patients.    Conclusion.  ThuFLEP provides sustained improvement in lower urinary tract symptoms, quality of life, and urodynamic parameters and may be considered an alternative to HoLEP and ThuLEP.