Efficacy of transurethral thulium laser vapoenucleation of the prostate combined with 12-o'clock urethral mucosal preservation for small-volume benign prostatic hyperplasia: a retrospective study.

PURPOSE: To evaluate the clinical efficacy of transurethral thulium laser vapoenucleation of the prostate (ThuVEP) combined with the 12-o'clock urethral mucosal preservation technique for treatment of small-volume benign prostatic hyperplasia (BPH), focusing on incidences of bladder neck contracture and urinary incontinence, as well as improvements in quality of life (QoL).

METHODS

This retrospective analysis included 102 patients with small-volume BPH who underwent the modified ThuVEP procedure between June 2018 and December 2024. The modified technique emphasized preservation of the urethral mucosa at the 12-o'clock position.

RESULTS

The mean preoperative prostate volume was 35.4 mL, mean operative time was 35 min (range, 25-50 min), and median catheterization time was 4 days. After a median follow-up of 27 months, all patients achieved satisfactory postoperative voiding. The median maximum urinary flow rate (Qmax) was 24.2 mL/s and median post-void residual volume (PVR) was 20 mL. Both postoperative the International Prostate Symptom Score (IPSS) and QoL score significantly improved (p < 0.01). Eight patients developed mild, transient urinary incontinence, which spontaneously resolved within 1 month. No bladder neck contracture occurred during follow-up.

CONCLUSION

ThuVEP combined with 12-o'clock urethral mucosal preservation provides robust relief of obstructive symptoms in patients with small-volume BPH; it has a high rate of immediate postoperative urinary continence and low incidence of bladder neck contracture. This modification represents a safe and effective surgical option for small-volume BPH, although long-term outcomes should be validated in larger cohorts with extended follow-up.