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Review
. 2020 Nov;46(6):419-426.
doi: 10.5152/tud.2020.20202. Epub 2020 Oct 9.

Is Thulium laser enucleation of prostate an alternative to Holmium and TURP surgeries - A systematic review?

Mudassir M Wani  1 , Seshadri Sriprasad  2 , Tahir Bhat  3 , Sanjeev Madaan  4
Affiliations
Review

Is Thulium laser enucleation of prostate an alternative to Holmium and TURP surgeries - A systematic review?

Mudassir M Wani et al. Turk J Urol. 2020 Nov.

Abstract

To assess efficacy and safety of Thulium laser enucleation of prostate (ThuLEP) for benign prostatic hyperplasia. It is a systemic review based on a comprehensive search of PubMed, Cochrane, and Google scholar databases from inception to 31 March 2020. All studies in English evaluating ThuLEP as well as those comparing it with Transurethral resection of prostate (TURP) and Holmium Laser enucleation of prostate (HoLEP) were enrolled. The primary outcome was to evaluate operative, postoperative, and functional outcomes (IPSS, QoL, Qmax, PVR) in patients undergoing ThuLEP. Secondary outcome was to compare operative, postoperative, and functional outcomes with TURP and HoLEP in comparative studies. Fourteen studies with a total of 2,562 patients were included in this review. 2,034 underwent ThuLEP, 349 underwent TURP, and remaining 139 had HoLEP. We found that ThuLEP is safe as well as efficacious in all age groups as well as across all prostate sizes and with all four functional outcomes (IPSS, QoL, Qmax, PVR) revealing marked improvement at 3, 6, 12, and 24 months. Compared to TURP and HoLEP, Thulep is non-inferior in terms of operative and functional outcomes and, in fact, is associated with lesser catheterization duration as well as shorter hospital stay. Further, Thulium fiber laser (TFL) has advantages of being light weight, having high frequency, less fiber degradation, and less energy consumption, making it cost effective for operational and maintenance purpose. ThuLEP is a safe, efficacious, and cost-effective procedure for BPE.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Preferred Reporting items for Systemic reviews and Meta-analyses flow sheet for study selction
Figure 2
Figure 2
Functional outcomes after ThuLEP IPSS: International Prostate Symptom Score; PVR: Post-Void residual; PSA: Prostate Specific Antigen; QoL: Quality of Life; Qmax: Maximum Flow rate
Figure 3
Figure 3
Pre-operative comparison Hb: Hemoglobin; HOLEP: Holmium laser enucleation of prostate; IPSS: International Prostate Symptom Score; PVR: Post-Void residual; PSA: Prostate Specific Antigen; ThuLEP: Thulium Laser enucleation of Prostate; TURP: Transurethral Resection of Prostate; QoL: Quality of Life; Qmax: Maximum Flow rate
Figure 4
Figure 4
Post-operative comparison Hb: Hemoglobin; HOLEP: Holmium laser enucleation of prostate; IPSS: International Prostate Symptom Score; PVR: Post-Void residual; PSA: Prostate Specific Antigen; ThuLEP: Thulium Laser enucleation of Prostate; TURP: Transurethral Resection of Prostate; QoL: Quality of Life; Qmax: Maximum Flow rate
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