Combined top-down approach with low-power thulium laser enucleation of prostate: evaluation of one-year functional outcomes

Objectives: To evaluate the safety and efficacy of combined top and down low power thulium laser enucleation of the prostate (ThuLEP). Patients and methods: Between May 2017 and May 2019, after institutional board review approval, successfully consented patients underwent combined top and down low power ThuLEP. We used a 30 -W Thulium laser with a 550 μm laser fiber and a 26 Fr continuous flow resectoscope. We collected data related to prostate size, enucleation time, morcellation time, perioperative complications, and early outcomes. Results: Sixty patients underwent combined Top and down low power ThuLEP with mean age 67 ± 8. Acute urine retention was the main indication for surgery in 22% of patients, while the remaining had mean IPPS score 26 ± 3. The mean prostate volume was 102 ± 25 ml and the mean Qmax was 6 ± 2 ml/sec. Mean operative time was 103 ± 25 min, while; mean enucleation time was 80 ± 12 min, and mean morcellation time was 17 ± 6 min. The mean enucleated prostate volume was 73 ± 16 g and the mean hemoglobin drop was 1 ± 0.2 mg/dl. There was no need for blood transfusion and the mean hospital stay was 18 ± 4 h and catheters were removed on discharge. The 1st visit was at one month, and we observed significant mean Qmax improvement18 ± 5 ml/s. Our results showed no significant change of IIEF-5 score at 12-month follow-up compared to baseline. Conclusion: Low-power Thulium enucleation with a combined top and down technique provided a safe and efficacious outcome, that may reduce strenuous wrist flexion and eliminate the need for high-power Thulium laser device.