Does pulse modulation technology improve endoscopic enucleation of the prostate? Real-world comparison of three contemporary laser platforms in 447 patients.

BACKGROUND: Anatomical Endoscopic enucleation of the prostate (AEEP) has emerged as a highly effective surgical treatment for benign prostatic enlargement, with multiple laser platforms now available. This study compares perioperative and early postoperative outcomes across three distinct laser systems. METHODS: We analysed 447 patients who underwent AEEP across seven centres between March and August 2025. Patients were divided into three groups: Group 1 (n = 184) treated with Holmium: YAG laser employing Magneto technology, Group 2 (n = 64) with high-power Holmium: YAG laser, and Group 3 (n = 199) with pulsed Thulium: YAG laser. Perioperative parameters, complications, and three-month functional outcomes were assessed. RESULTS: Group 3 demonstrated superior operative efficiency with shortest median total operation time (45 vs. 60 vs. 65 min, p < 0.001) and enucleation time (22 vs. 33 vs. 33 min, p < 0.001). No patients in Group 3 required electrocautery for haemostasis compared to 20.7% in Group 1 and 35.9% in Group 2 (p < 0.001). No patient required blood transfusion. No major complications occurred. Readmission for bleeding requiring manual clot evacuation occurred in 6.2% of Group 2 patients and 0.5% of Group 3 patients, with no cases in Group 1 (p < 0.001). Early and late urinary incontinence was significantly lower in Group 3 versus Groups 1 and 2. All platforms achieved substantial functional improvements at 3-month follow-up. No major complications. CONCLUSIONS: While all three laser platforms achieved effective surgical outcomes with favourable safety profiles, the pulsed Thulium: YAG and Holmium: YAG lasers with magneto technology were associated with advantages in hemostasis and continence outcomes.