Thulium fiber laser enucleation of the prostate (ThuFLEP) for the treatment of benign prostatic obstruction: a comparative study of men with prostate volumes ≥ 150 mL and < 150 mL.

Purpose: We aimed to evaluate the outcomes of Thulium fiber laser enucleation of the prostate (ThuFLEP) in men with prostate volumes (PV) ≥ 150 mL and to compare them with those with PV < 150 mL.

Methods: We retrospectively analyzed the patients who underwent ThuFLEP between December 2020 and June 2024 for benign prostatic obstruction (BPO). Patients were categorized into two groups according to prostate volume, with Group 1 including those with PV < 150 mL (n = 355) and Group 2 including those with PV ≥ 150 mL (n = 147). Perioperative and postoperative functional outcomes, as well as complications, were evaluated and compared.

Results: Both groups demonstrated significant improvements in functional parameters (International Prostate Symptom Score-IPSS, maximal urinary flow rate-Qmax and postvoid residual urine volume-PVR) compared with baseline values at the 1, 6 and 12 months postoperatively. Postoperative IPSS, QoL scores, Qmax, PVR values, and rates of urge urinary incontinence (UUI) and stress urinary incontinence (SUI) were comparable between groups at all follow-up intervals (p > 0.05). No patient exhibited postoperative SUI or UUI at 6 and 12 months postoperatively. Complication rates were similar between groups, and no Grade ≥ 4 Clavien-Dindo complications occurred.

Conclusion: ThuFLEP is a safe and effective LEP technique for very large prostates (≥ 150 mL). It yields significant improvements in postoperative functional outcomes with low perioperative complication rates, supporting its use as a minimally invasive alternative for BPO in routine endourology practice.