A comparison between thulium fiber laser enucleation of the prostate and robot-assisted simple prostatectomy in the surgical management of large benign prostatic hyperplasia.

Objective: Thulium fiber laser enucleation of the prostate (ThuFLEP) and robot-assisted simple prostatectomy (RASP) are two options for treating large benign prostatic hyperplasia. The most appropriate technique remains a matter of debate. We evaluated the efficacy and safety of ThuFLEP compared to RASP. Methods: Between January 2020 and December 2023, all patients who underwent either RASP or ThuFLEP for a prostate volume >80 mL were retrospectively included. The surgical procedure choice was left to the surgeon's and patient's discretion. Preoperative patient evaluation included the assessment of functional parameters. The groups were compared. Results: A total of 234 patients were included: 106 (45%) underwent RASP and 128 (55%) underwent ThuFLEP. The mean operative time was shorter in the ThuFLEP group compared to the RASP group (106.4 with standard deviation [SD] 46.1 min vs. 123.2 [SD 32.8] min, p=0.012). The mean lengths of catheterization and stay were significantly longer in the RASP group (5.0 [SD 3.9] days vs. 1.7 [SD 2.0] days, p=0.009 [catheterization] and 4.9 [SD 3.0] days vs. 1.9 [SD 1.8] days, p=0.009 [stay]). The overall complication rate was significantly higher in the ThuFLEP group (12% vs. 2.8% in the RASP group, p=0.022). However, we did not observe significant differences in major complications (Clavien-Dindo ≥3) between the two groups (four [3.1%] in the ThuFLEP group vs. one [0.94%] in the RASP group, p=0.073). At 3 months, the rate of stress urinary incontinence was 4.7% after ThuFLEP and 1.9% after RASP (p=0.2). Finally, the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups, but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group (p=0.012). Conclusion: Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia. ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.