Pulsed Thulium:YAG laser enucleation versus open simple prostatectomy for large-gland benign prostatic hyperplasia: a retrospective comparative observational study.

BACKGROUND

Evidence on high-peak-power pulsed Thulium:YAG laser enucleation (p-ThuLEP) remains limited, particularly for large prostates. This study aimed to compare perioperative, functional, and safety outcomes between p-ThuLEP and open simple prostatectomy (OSP) in patients with large-gland benign prostatic hyperplasia (BPH). We compared early perioperative, functional, and bleeding-related outcomes between p-ThuLEP and OSP in patients with large-gland BPH.

METHODS

We conducted a retrospective comparative observational study including 98 consecutive patients with prostate volumes 80-150 mL treated between January 2023 and May 2025 in a tertiary academic center. Cases were selected in a 1:1 ratio to obtain comparable group sizes; no formal matching procedure was performed. The primary outcome was bleeding-related complications (transfusion and postoperative hematuria). Secondary outcomes included perioperative parameters and early functional results [International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), prostate-specific antigen (PSA)]. Multivariable logistic regression adjusted for prostate volume, anticoagulant use, and positive urine culture.

RESULTS

p-ThuLEP significantly reduced hospital stay [mean difference -3.04 days; 95% confidence interval (CI): -4.09 to -2.16; P=0.002] and catheterization time (mean difference -6.42 days; 95% CI: -7.85 to -4.73; P=0.001), as well as transfusion rates (0% vs. 12.2%, P=0.01). Both groups demonstrated comparable early improvements in IPSS and Qmax. In multivariable analysis, anticoagulant use independently predicted hematuria [odds ratio (OR) 9.39; 95% CI: 1.56-56.45; P=0.01], whereas surgical approach showed a strong but non-significant association (OR 5.84; 95% CI: 0.95-35.92; P=0.057). Prostate volume was not independently associated with bleeding events.

CONCLUSIONS

In this real-world cohort of large prostates, no significant differences in early functional outcomes were detected between p-ThuLEP and OSP, while p-ThuLEP was associated with shorter hospitalization and lower transfusion rates. Given the retrospective design and short follow-up, these findings primarily reflect early perioperative and short-term results. p-ThuLEP may represent a minimally invasive option in experienced centers. Prospective studies are warranted to confirm long-term durability.