Comparative analysis of thulium fiber laser enucleation of the prostate (ThuFLEP) and holmium laser enucleation of the prostate (HoLEP) in the management of benign prostatic hyperplasia: A systematic review and meta-analysis.
Basri Çakıroğlu, Tuğrul Cem Gezmiş
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In 30 seconds
This systematic review and meta-analysis compared thulium fiber laser enucleation (ThuFLEP) with holmium laser enucleation (HoLEP) for benign prostatic hyperplasia, including randomized trials and comparative observational studies. Across 12 studies and 1248 men, postoperative symptom scores, urinary flow, and residual urine were comparable. ThuFLEP was associated with shorter operative time (mean difference -12.4 min; 95% CI -20.1 to -4.7), shorter catheterization and hospital stays, and more favorable bleeding-related outcomes. Overall and high-grade complication rates were similar.
Key findings
- Postoperative IPSS, Qmax, and post-void residual volume showed no meaningful differences between ThuFLEP and HoLEP.
- ThuFLEP was associated with shorter operative time (MD -12.4 min; 95% CI -20.1 to -4.7).
- Catheterization duration and hospital stay were shorter with ThuFLEP (MD -0.58 days; 95% CI -0.81 to -0.35; and MD -0.73 days; 95% CI -1.02 to -0.44, respectively).
- Bleeding-related outcomes favored ThuFLEP, while overall and Clavien-Dindo ⩾ III complication rates were similar.
Why it matters
The findings suggest that both procedures can provide comparable functional improvement, while ThuFLEP may reduce perioperative time in hospital and bleeding-related outcomes. These differences may inform discussion of procedural options, but the evidence combines randomized and observational comparisons and does not establish long-term comparative durability.
What to keep in mind
The review included both randomized and comparative observational studies; the authors call for larger multicenter randomized trials with long-term follow-up to confirm durability and assess cost-effectiveness.