Thulium trumps holmium laser enucleation for benign prostate hyperplasia

Thulium (ThuLEP) compared with holmium (HoLEP) laser enucleation of prostate yields faster symptom improvement and better safety outcomes in patients with benign prostatic hyperplasia (BPH), a recent meta-analysis has found.

Drawing from the databases of PubMed, Embase, and the Cochrane Library, researchers included eight eligible studies, corresponding to a total of 2,125 BPH patients. Only those that directly compared ThuLEP with HoLEP through randomized controlled trials or prospective or retrospective controlled trials were included.

Compared with HoLEP, patients undergoing ThuLEP had significantly shorter length of hospital stay (mean difference [MD], –0.41, 95 percent confidence interval [CI], –0.72 to –0.10) and a lower decrease in haemoglobin levels (MD, –0.37, 95 percent CI, –0.61 to –0.14). In contrast, no between-arm differences were reported for the operation, enucleation, morcellation, and catheterization times.

Postoperative outcomes were assessed after 3, 6, and 12 months of follow-up. International Prostate Symptom Scores (IPSS) were significantly better in ThuLEP patients at 3 months (MD, –0.96, 95 percent CI, –1.27 to –0.65). No significant between-arm differences were reported for other outcome measures, such as quality of life and post-void residual urine volume, across all other time points. Likewise, the difference in IPSS was attenuated by months 6 and 12.

“Our meta-analysis demonstrates that ThuLEP, compared with HoLEP, has better security and faster improvement of symptoms. However, in a short period in the future, limited by the capacity of different medical institutions, laser power, and the proficiency of surgeons, it will take some time to fully demonstrate its advantages in the field of BPH,” the researchers said.

“A larger sample size, multicentre, and longer follow-up randomized controlled trials are still needed to support our conclusions,” they added.