Efficacy and safety of modified transurethral thulium laser enucleation-resection with apical vaporization cutting versus anatomic thulium laser enucleation for large-volume (> 80 ml) benign prostatic hyperplasia: A retrospective comparative study.

To compare the perioperative outcomes, efficacy, and safety of modified transurethral thulium laser enucleation-resection (ThuLERP) versus standard anatomic thulium laser enucleation (ThuLEP) for large-volume benign prostatic hyperplasia (BPH) (> 80 ml), with a primary focus on early urinary continence recovery. We retrospectively analyzed 215 patients with large-volume BPH treated between January 2021 and December 2024. Patients were segregated into the ThuLERP group (n = 110), receiving anatomical enucleation of the middle and lateral lobes combined with vaporization cutting at the prostatic apex and anterior commissure, or the ThuLEP group (n = 105), undergoing traditional 3-lobe anatomical enucleation. Baseline characteristics, including prostate volume (102.5 ± 21.3 ml vs 104.1 ± 22.5 ml), were comparable between groups. Primary outcomes assessed continence at 1 week, 1 month, and 3 months; secondary outcomes evaluated perioperative metrics and functional recovery at 6 months. All procedures were successful. The ThuLERP group demonstrated significantly shorter total operation time (65.2 ± 18.5 minutes vs 79.4 ± 20.1 minute, P < .01) and enucleation time (48.1 ± 15.3 minutes vs 62.5 ± 17.8 minutes, P < .01) compared to ThuLEP. Safety outcomes favored ThuLERP, showing a lower incidence of postoperative hematuria requiring intervention (6.4% vs 12.4%, P < .05) and no reoperations for bleeding in the ThuLERP group compared to 1.9% in the ThuLEP group, although this difference was not statistically significant (P > .05). Notably, ThuLERP resulted in superior early continence: incontinence rates were significantly lower at 1 week (8.2% vs 21.9%, P < .01) and 1 month (2.7% vs 9.5%, P < .05). By 3 months, continence rates were comparable (> 98%). Both groups achieved similar significant improvements in International Prostate Symptom Score, quality of life, maximum urinary flow rate, and post-void residual at 6 months. Modified ThuLERP is as effective as standard ThuLEP regarding long-term functional outcomes for large-volume BPH. However, it offers distinct advantages by reducing operative time, improving hemostasis, and significantly accelerating the recovery of early urinary continence.