- Design
- Systematic review and meta-analysis of RCTs and cohorts
- Population
- 3,509 men undergoing ThuFLEP or HoLEP
- Primary outcome
- IPSS, Qmax, complications
- Effect
- IPSS at 3 months MD -1.04 (-1.81 to -0.28); other outcomes comparable
This meta-analysis compared thulium fibre laser enucleation (ThuFLEP) with conventional holmium laser enucleation (HoLEP) in seven comparative populations, 3,509 men, mostly from cohort studies.
ThuFLEP gave a slightly lower symptom score at three months (IPSS difference -1.04, 95% CI -1.81 to -0.28), below what patients would notice. Flow rate differences were small and inconsistent. Stress and urge incontinence appeared less frequent with ThuFLEP (RR 0.75 and 0.39), but both results depended on one large registry and disappeared when it was excluded. Hospital stay and most complications did not differ. Certainty was mostly low or very low.
The practical answer is that the laser matters less than the surgeon's experience with it. Units should choose on cost, availability and training.
- Offer anatomical enucleation with whichever laser your unit is experienced with
- Do not expect a meaningful symptom difference between thulium and holmium
- The incontinence advantage for thulium is not robust
- Base purchasing decisions on cost, maintenance and training rather than outcomes
Why it matters
It removes outcome as a reason to switch platforms.
The statistics, in plain English
A 1-point IPSS difference is smaller than the roughly 3-point change patients perceive. A result that depends on one study is fragile.
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