ThuFLEP noninferior to HoLEP in terms of functional outcomes

Thulium fiber laser enucleation of the prostate (ThuFLEP) was noninferior to Holmium laser enucleation of the prostate (HoLEP) in terms of functional outcomes through 24 months in patients with benign prostatic obstruction (BPO), according to a trial presented at EAU 2026.

At follow-up, both treatment groups showed sustained and significant improvements in median International Prostate Symptom Score (IPSS), which decreased from 21 at baseline to 3 at 24 months in the ThuFLEP group and from 20 to 4 in the HoLEP group (p<0.001), with no significant intergroup differences at any timepoint (all p>0.01).

Additionally, patient-reported quality of life (QoL) was stable, as the median score dropped from 4 to 1 in both groups (p<0.001).

Taken together, the results confirm that ThuFLEP was noninferior to HoLEP for functional outcomes, as assessed by IPSS and QoL scores at or after the 2-year timepoint, according to study author Dr Maximilian Filzmayer from the University Hospital of Goethe University Frankfurt, Frankfurt, Germany.

The researchers conducted a prospective study involving 150 patients to assess the long-term efficacy and safety of ThuFLEP and HoLEP for managing BPO. Participants were randomized in a 1:1 ratio to undergo either the ThuFLEP (n=74) or HoLEP (n=76) procedures. [EAU 2026, abstract A0352]

With regard to secondary functional outcomes, no significant differences were observed between the ThuFLEP and HoLEP groups, said Filzmayer.

Catheter dependence beyond 1 month was absent in both groups, and the use of lower urinary tract symptom medications decreased dramatically from 80 percent before the procedure to just 8 percent after 2 years.

Moreover, the ejaculatory function was observed to decline as expected, according to Filzmayer, with the MSHQ-EjD-SF* score decreasing from 7 to 1, while the ejaculation-related bother remained unchanged at 2.

Both groups also showed modest improvement in erectile function, as indicated by an increase in the IIEF-5** score from 10 to 16.

In terms of safety, three strictures were observed in the ThuFLEP group, while none were observed in the HoLEP group. However, the difference was not statistically significant.

Persistent incontinence was reported in five patients undergoing ThuFLEP and four patients undergoing HoLEP, with de novo incontinence rates of 2.5 percent and 4.4 percent, respectively, which were also not statistically significant, Filzmayer noted.

The findings of this study were consistent with a previous study, which showed that ThuFLEP and HoLEP yielded similar functional outcomes and low complication rates, indicating that these procedures serve as viable alternatives for patients with BPO. [World J Urol 2024;42:374]

Overall, the 24-month outcomes in patients undergoing ThuFLEP remained noninferior to those undergoing HoLEP, and demonstrated comparable safety, continence, medication use reduction, and sexual function results over time, said Filzmayer.

Therefore, “ThuFLEP and HoLEP both represent effective, durable, and safe surgical options for the treatment of BPO,” he concluded.