A comparison between thulium fiber laser enucleation of the prostate and robot-assisted simple prostatectomy in the surgical management of large benign prostatic hyperplasia

Abstract

Thulium fiber laser enucleation of the prostate (THUFLEP) and robot-assisted simple prostatectomy (RASP) are two options for treating large-volume adenomas. The most appropriate technique remains a matter of debate. We evaluated the efficacy and safety of THUFLEP compared to RASP. Between January 2020 and December 2023, all patients who underwent either RASP or THUFLEP for a prostate volume >80 mL were retrospectively included. The surgical procedure choice was left at the surgeon’s and patient’s discretion. Preoperative patient evaluation included the assessment of functional parameters. The groups were compared. A total of 234 patients were included: 106 (45%) underwent RASP and 128 (55%) underwent THUFLEP. The mean operative time was shorter in the THUFLEP group compared to the RASP group (106.4 with standard deviation [SD] 46.1 min vs. 123.2 [SD 32.8] min, p =0.012). The mean duration of catheterization and hospitalization was longer in the RASP group (5.0 [SD 3.9] days vs. 1.7 [SD 2.0] days, p =0.009 and 4.9 [SD 3.0] days vs. 1.9 [SD 1.8] days, p =0.009, respectively). The overall complication rate was significantly higher in the THUFLEP group (12% vs. 2.8% in the RASP group, p =0.021). However, we did not observe significant differences in major complications (Clavien-Dindo ≥3) between the two groups (4 [3.1%] in the THUFLEP group vs. 1 [0.9%] in the RASP group ( p =0.071). At 3 months, the rate of stress urinary incontinence was 4.7% after THUFLEP and 1.9% after RASP ( p =0.2). Finally, the quality of life index and maximum flow (Q max ) were comparable between the THUFLEP and RASP groups, but the International Prostate Symptom Scor at 3 months was lower in the RASP group. Both THUFLEP and RASP are safe techniques with comparable functional outcomes for large-volume prostate adenomas. THUFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.