Prospective single-center study comparing RealPulse® Thulium:YAG and Holmium:YAG laser enucleation of the prostate.

PURPOSE: Holmium:YAG laser enucleation is the current golden standard for endoscopic enuclation of the prostate. Newer laser technologies, such as the RealPulse® Thulium:YAG system, offer different laser–tissue interactions that might affect enucleation efficiency and perioperative outcomes, yet comparative evidence remains limited. The aim of this study is to evaluate the clinical efficacy, safety profile, and short- and intermediate-term outcomes of both lasers.

METHODS

In total, 98 men with benign prostatic obstruction, refractory to medication, were included between 13/12/2023 until 13/06/2024. Demographics, intra-operative, post-operative data and PROMs were prospectively collected. Patients were randomly assigned to Ho:YAG laser (group A) or to RealPulse® Tm:YAG laser (group B). SPSS version 29 (SPSS Inc. Chicago. IL, USA) was used to analyse all the data.

RESULTS

No significant difference in demographic and pre-operative parameters was found, except for prostate volume which was significantly higher in group B (p = 0.014). Similar enucleation efficiency, coagulation duration, enucleated tissue weight, catheterization time and hospital stay were seen with both lasers. The improvement of Qmax at 3 months postoperatively was similar in both groups (14.41 ± 9.38 in group A vs. 11.12 ± 10.74 in group B; p = 0.349). As well as the improvement in IPSS score at 6 weeks, 3 months and 1 year postoperatively. ICIQ-UI reports have a similar decline after 6 weeks with normalization on 3 months and 1 year.

CONCLUSION

The Ho:YAG Laser and the RealPulse® Tm:YAG laser showed similar efficacy, safety and short- and intermediate-term outcomes.