medigraphic.com
Organo Oficial de la Sociedad Mexicana de Urología

2026, Number 1

<< Back Next >>

Rev Mex Urol 2026; 86 (1)

Fiber laser enucleation of the prostate (ThuFLEP): learning curve and early surgical experience in a training program

García SJ, Zapata-González JA, Robles-Torres JI, González-Garza R, Maldonado-Calderón JL, Gutiérrez-González A

Language: Spanish
References: 14
Page: 1-13
PDF size: 625.90 Kb.


ABSTRACT

Objective: to describe the initial experience and evaluate the learning curve of Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) in a training program. Methods: an ambispective study included consecutive patients with benign prostatic enlargement who underwent ThuFLEP between March 2024 and January 2025. Collected variables included demographics, operative times, enucleation and morcellation efficiency, perioperative complications, and functional outcomes at 3 months. Learning progression was assessed using linear regression of enucleation efficiency and operative time across consecutive cases, and by stratifying patients into quartiles according to case order. Results: thirty‑eight patients were included. Mean prostate volume was 74.5 ± 19.6 g, and mean operative time was 83.6 ± 40.3 minutes. Mean enucleation efficiency was 0.75 ± 0.30 g/min. Total operative time decreased by approximately 3 minutes per case (p < 0.01). Most complications were low grade (Clavien-Dindo grade I–II). Significant improvement at 3 months was observed in PSA, IPSS, QoL, and PVR (all p < 0.0001). Operative proficiency reached around case 10-20. Limitations of this study: small sample size, ambispective design, and lack of a comparative group. Originality: this is the first Mexican study describing early experience and the learning curve of ThuFLEP in a training program. Conclusions: ThuFLEP shows a reproducible learning curve in a supervised training environment. Its safety profile, hemostatic properties, and predictable tissue interaction support its use as a technique for surgical education.


REFERENCES

  1. European Association of Urology 1.Management of Non-neurogenic Male LUTS. 2024.

  2. Cornu JN, Ahyai S, Bachmann A, de la Rosette J,Gilling P, Gratzke C, et al. A Systematic Reviewand Meta-analysis of Functional Outcomesand Complications Following TransurethralProcedures for Lower Urinary Tract SymptomsResulting from Benign Prostatic Obstruction:An Update. European Urology. 2015;67(6):1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017.

  3. Herrmann TRW, Liatsikos EN, NageleU, Traxer O, Merseburger AS. EAUGuidelines on Laser Technologies. EuropeanUrology. 2012;61(4): 783–795. https://doi.org/10.1016/j.eururo.2012.01.010.

  4. Enikeev D, Taratkin M. Thulium Fiber Laser:Bringing Lasers to a Whole New Level. EuropeanUrology Open Science. 2022;48: 31–33. https://doi.org/10.1016/j.euros.2022.07.007.

  5. Enikeev D, Glybochko P, Rapoport L, Gahan J,Gazimiev M, Spivak L, et al. A Randomized TrialComparing The Learning Curve of 3 EndoscopicEnucleation Techniques (HoLEP, ThuFLEP, andMEP) for BPH Using Mentoring Approach-Initial Results. Urology. 2018;121: 51–57.https://doi.org/10.1016/j.urology.2018.06.045.

  6. Hwang JC, Park SM, Lee JB. Holmiumlaser enucleation of the prostate for benignprostatic hyperplasia: effectiveness, safety, andovercoming of the learning curve. Korean Journalof Urology. 2010;51(9): 619–624. https://doi.org/10.4111/kju.2010.51.9.619.

  7. Al Barajraji M, Moussa I, Soscia GL, Naudin M,Lempereur L, Coscarella M. Evaluation of thelearning curve for Thulium fiber laser enucleationof prostate (ThuFLEP): retrospective studyof a single-surgeon experience in real-worldsettings. World Journal of Urology. 2024;42(1):444. https://doi.org/10.1007/s00345-024-05167-y.

  8. Perri D, Pacchetti A, Morini E, Besana U,Mazzoleni F, Verzotti E, et al. Evaluation of thelearning curve for Thulium laser enucleation ofthe prostate in a contemporary cohort. WorldJournal of Urology. 2024;42(1): 246. https://doi.org/10.1007/s00345-024-04958-7.

  9. Seki N, Mochida O, Kinukawa N, Sagiyama K,Naito S. Holmium laser enucleation for prostaticadenoma: analysis of learning curve over thecourse of 70 consecutive cases. The Journal ofUrology. 2003;170(5): 1847–1850. https://doi.org/10.1097/01.ju.0000092035.16351.9d.

  10. Robert G, Cornu JN, Fourmarier M, Saussine C,Descazeaud A, Azzouzi AR, et al. Multicentreprospective evaluation of the learning curveof holmium laser enucleation of the prostate(HoLEP). BJU international. 2016;117(3): 495–499. https://doi.org/10.1111/bju.13124.

  11. Elmansy HM, Kotb A, Elhilali MM. Holmiumlaser enucleation of the prostate: long-termdurability of clinical outcomes and complicationrates during 10 years of followup. The Journal ofUrology. 2011;186(5): 1972–1976. https://doi.org/10.1016/j.juro.2011.06.065.

  12. Agreda Castañeda F, Buisan Rueda Ó, ArealCalama JJ. The complications of the HoLEPlearning curve. A systematic review. ActasUrologicas Espanolas. 2020;44(1): 1–8. https://doi.org/10.1016/j.acuro.2019.08.008.

  13. Brunckhorst O, Ahmed K, Nehikhare O, MarraG, Challacombe B, Popert R. Evaluation of theLearning Curve for Holmium Laser Enucleationof the Prostate Using Multiple OutcomeMeasures. Urology. 2015;86(4): 824–829.https://doi.org/10.1016/j.urology.2015.07.021.

  14. Tyson MD, Lerner LB. Safety of holmium laserenucleation of the prostate in anticoagulatedpatients. Journal of Endourology. 2009;23(8):1343–1346. https://doi.org/10.1089/end.2009.0013.




2020     |     www.medigraphic.com