Thulium fiber laser enucleation of the prostate (ThuFLEP): Tips and tricks

Objective To report the technique for thulium fiber laser enucleation of the prostate, making emphasis on important tips and tricks to have success during the surgery and in the post-operative time. Patient The case of a 63 year-old male with no comorbidities presented with a 5-year history of oLUTS. Evaluation revealed a severely symptomatic IPSS score and a 75cc prostate. ThuFLEP was considered given to the symptoms and prostate size. Surgical procedure ThuFLEP was performed with the following approach: careful disinsertion of the prostatic apex, progression through posterior, lateral, and anterior planes, bladder neck fiber transection, mucosal bridge transection, endoscopic morcellation, and coagulation. Results Enucleation and morcellation times were 35 and 12 minutes, respectively. Patient was discharged after 3 hours of bladder irrigation, and the Foley catheter was removed on PO3. Immediate continence was achieved. The recovery went without complications. Discussion Thulium fiber laser is a useful technology for prostate enucleation. Key technical tips to success during the procedure are maintaining a clear view, wide shoulder-to-shoulder movements, and transecting the vertical fibers at the bladder neck in the anterior plane. Creating an anterior flat at the level of the sphincter and preserving the semicircular fibers near the apex may promote early continence.