Thulium Fiber Laser Enucleation of the Prostate: Prospective Study of Mid- and Long-Term Outcomes in 1328 Patients

Petov, Vladislav; Babaevskaya, Diana; Taratkin, Mark; Chuvalov, Leonid; Lusuardi, Lukas; Misraï, Vincent; Sukhanov, Roman; Scoffone, Cesare Marco; Enikeev, Dmitry

doi:10.1089/end.2022.0029

Cited by 15 publications

(12 citation statements)

References 28 publications

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“…EF after TURP impaired in 34% of patients (18% in patients after ThuFLEP) and it improved in 21% of them (26% after ThuFLEP) (36).. The safety profile for ThuFLEP also was also acceptable with an overall complication rate of 9.7%, Clavien-Dindo grade III complications only in 1.9% of cases (37). Also, Enikeev et al compared the severity of irritative symptoms after HoLEP and ThuFLEP (38).…”

Section: Thulium Fiber Laser For Soft Tissues: Clinical Trialsmentioning

confidence: 99%

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

et al. 2022

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IntroductionThe Thulium fiber laser (TFL) is a new device that in contrast to the other solid-state YAG-based lasers takes a different approach to pulse formation allowing for two different modes: in the QCW (quasi-continuous wave) function, TFL is convenient for soft tissue surgery and in the SP (Superpulsed) mode it is highly effective in lithotripsy. Thus, unlike the other thulium lasers (Tm : YAG), TFL can be used in a wide range of surgical procedures.Materials and MethodsWe conducted a systematic search in 3 databases: Medline, Scopus and Cochrane library. All original articles (both preclinical and clinical) on TFL application in soft tissue surgery were included in data analysis.ResultsIn terms of its cutting properties, QCW TFL is not inferior to the other thulium lasers, and in fact allows for decreased carbonization (due to lower heat production) compared to continuous lasers (e.g. Tm : YAG). It has been used successfully in endoscopic enucleation of the prostate (EEP) and in en bloc resection of bladder tumors (ERBT). The efficacy and safety of this laser is comparable to TURP and simple prostatectomy, but the recovery period is shorter and the learning curve is slightly superior to other endoscopic procedures. There are no significant differences between TFL and Ho : YAG in terms of efficacy and safety during EEP. Unfortunately, there are no clinical studies that analyse the efficacy and safety of SP TFL in EEP or ERBT.ConclusionTFL is a safe and effective tool for BPH surgery. In terms of parameters, it is in no way inferior to Tm : YAG or Ho : YAG during EEP. However, TFL surpasses these lasers in terms of usability and serviceability. These advantages are likely to render it more popular over time.

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Section: Thulium Fiber Laser For Soft Tissues: Clinical Trialsmentioning

confidence: 99%

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

et al. 2022

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“…According to Petov et al [ 12 ], ThuFLEP is considered an effective and safe method of endoscopic enucleation characterized by improvement of all functional parameters (IPSS, QoL, PVR, Qmax) after surgery (p<0.05) with durable improvement lasting for up to 3 years of follow-up. Similar results were reported by Bozzini et al [ 10 ] with 3 months of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…According to Petov et al [ 12 ], ThuFLEP has a low incidence of complications after 3 years of follow-up. Stress urinary incontinence was observed in 1.2% of patients, urethral stricture in 1.1%, and bladder neck contracture in 0.9% of patients [ 12 ]. This is similar to our data, but we had an even lower percentage of late complications: only 2 patients (0.5% of total) from the ThuFLEP group had stress urinary incontinence lasting more than 3 months.…”

Section: Discussionmentioning

confidence: 99%

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Propensity score-matched analysis comparing perioperative, functional, and safety outcomes between thulium fiber laser and bipolar enucleation of the prostate performed by a single surgeon with two years of follow-up

Kamalov,

Sorokin,

Dzitiev

et al. 2024

Investig Clin Urol

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Purpose To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (ThuFLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis. Materials and Methods Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release. Results Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar. Conclusions ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia.

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“…In letzter Zeit wurden zwei Hochleistungslaser in die klinische Praxis für AEEP eingeführt, nämlich HoLEP mit Moses-Technologie (MoLEP) [19] und die Thulium-Faserlaser-Enukleation der Prostata (Thu(F)LEP) [20]. Wie oben bereits erwähnt, führt der TFL durch die kürzere Wellenlänge und das höhere Absorptionsspektrum in Wasser nicht nur zu Vorteilen in der Lithotripsie, sondern auch zu einer höheren Energiedichte an der Spitze der Laserfaser, was effektivere Ablations-und Koagulationsfähigkeiten im Gewebe ermöglicht [21].…”

Section: Introductionunclassified

Thulium oder Holmium-Laser oder beides: wo geht die Reise hin?

Becker,

Hook,

Gross

et al. 2024

Aktuelle Urol

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ZusammenfassungDer Holmium:YAG-Laser war in den letzten drei Jahrzehnten der Goldstandard für die Laserlithotripsie und seit Ende der 1990er Jahre auch für die Enukleation der Prostata. Nachdem die gepulsten Thulium-Faserlaser (TFL) ihre Wirksamkeit in in-vitro Experimenten demonstriert haben, wurden sie vor einigen Jahren auf dem Markt eingeführt. Die ersten klinischen Ergebnisse zu dem TFL für die Lithotripsie und die Enukleation sind sehr erfolgsversprechend. Neben dem TFL wurde auch ein gepulster Thulium:YAG-Festkörperlaser eingeführt, zu dem allerdings noch wenige klinische Daten vorliegen. Dieser Artikel zielt darauf ab, die wichtigsten technologischen Unterschiede zwischen dem Ho:YAG-Laser und den gepulsten Thuliumlaser zu überprüfen und die ersten klinischen Ergebnisse zur Steinlithotripsie und zur Laserenukleation gegenüberzustellen bzw. zu diskutieren.In-vitro-Studien zeigen eine technische Überlegenheit des TFL im Vergleich zum Ho:YAG-Laser. Da der TFL jedoch noch eine neue Technologie ist, stehen derzeit nur begrenzte Studien zur Verfügung und die optimalen Einstellungen für die Lithotripsie sind noch nicht festgelegt. Bei der Enukleation scheinen die Unterschiede des TFL zu einem Hochleistungs-Ho:YAG-Laser klinisch nicht relevant zu sein. Erste Studien zum gepulsten Tm:YAG-Laser zeigen zwar vielversprechende Ergebnisse, jedoch liegen noch keine vergleichenden Studien vor.Die gepulsten Thuliumlaser haben das Potenzial, eine Alternative zum Ho:YAG-Laser zu sein. Es sind jedoch noch weitere Studien erforderlich, um den optimalen Laser für die Enukleation und die Lithotripsie von Harnsteinen unter Berücksichtigung aller Parameter, einschließlich Wirksamkeit, Sicherheit und Kosten, zu bestimmen.

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Thulium Fiber Laser Enucleation of the Prostate: Prospective Study of Mid- and Long-Term Outcomes in 1328 Patients

Cited by 15 publications

References 28 publications

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

Propensity score-matched analysis comparing perioperative, functional, and safety outcomes between thulium fiber laser and bipolar enucleation of the prostate performed by a single surgeon with two years of follow-up

Thulium oder Holmium-Laser oder beides: wo geht die Reise hin?

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