Design: Systematic review and meta-analysis of randomised and cohort studies
Population: 3,509 men undergoing ThuFLEP or conventional HoLEP
Primary outcome: IPSS, Qmax, complications and continence
Effect: IPSS at 3 months −1.04 (−1.81 to −0.28); incontinence differences not robust

This meta-analysis compared thulium fibre laser enucleation of the prostate (ThuFLEP) with conventional holmium laser enucleation (HoLEP, without MOSES pulse modulation) across seven comparative populations totalling 3,509 men, mostly from non-randomised cohorts.

ThuFLEP gave a small reduction in symptom score at 3 months (−1.04 points, 95% CI −1.81 to −0.28), of uncertain clinical importance. Flow rate differences were small and changed direction over time, and randomised subgroups were neutral. Stress and urge incontinence appeared less frequent with ThuFLEP (RR 0.75 and 0.39), but both estimates depended on one large registry and disappeared when it was removed. Hospital stay and most complications did not differ. Certainty was mostly low or very low.

The practical conclusion is that the laser matters less than the surgeon's experience with enucleation. Units choosing a platform can base the decision on cost, maintenance and training.

Choose an enucleation laser on cost, availability and surgeon training rather than expected outcome differences
Counsel patients on early transient incontinence regardless of laser
Audit symptom scores, flow and incontinence in your own series

Why it matters

Laser platform choices carry large capital costs, and the evidence does not favour one over the other.

The statistics, in plain English

A 1-point symptom score difference is below the roughly 3-point change patients usually notice. When a result disappears after removing one study, it depends on that study rather than on consistent evidence.