Study of the efficiency of thulium fiber laser enucleation of the prostate using a modulated pulse

Karakotov T.T., Lee Y.A., Dymov A.M., Gazimiev M.A.

Institute for Urology and Human Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

Introduction. The thulium fiber laser (TFL) is a relatively new certified system with unique physical properties that make it a potentially ideal energy source for endoscopic enucleation of the prostate (EEP). A specially designed modulated pulse has recently been introduced to enhance mechanical tissue dissection, similar to what is clearly observed during holmium laser enucleation. Evaluating the efficiency of this new pulse mode was designated as the primary endpoint of our study. Secondary endpoints included the quality of mechanical dissection, degree of carbonization, and hemostasis. The study was approved by the Local Ethics Committee of Sechenov University (Protocol No. URO-LEP3-1940, 05.06.2022). Materials and methods. The study was carried out from September 2023 to September 2024. A total of 80 patients scheduled for laser enucleation of the prostate were enrolled and randomized in blocks into two groups (40 patients each): a DP group (Dissect Pulse), in which enucleation was performed using a modulated pulse mode, and an SP group (Standard Pulse), in which enucleation was performed using the standard pulse mode. All procedures were carried out at the Urology Clinic of Sechenov University. Statistical analysis was performed using IBM SPSS Statistics (version 27.0.1.0) Results. The median duration of the procedure was 55 minutes in the DP group and 60 minutes in the SP group (p=0.495). In all patients, the urethral catheter was removed on postoperative day 2. Both groups demonstrated a significant increase in maximum urinary flow rate, as well as a reduction in IPSS and QoL scores at 3 months. No significant differences were observed between the groups in functional outcomes of surgical treatment or in complication rates. The degree of mechanical tissue dissection was significantly higher in the DP group (p<0.001). A trend toward reduced tissue carbonization was noted (p=0.18). Conclusion. The technological advancement of TFL, a modulated pulse shape, demonstrates improved mechanical tissue dissection and reduced carbonization effect. As clinical experience with this technology grows, it may emerge as the preferred choice for surgeons, offering an optimal balance between a cut precision, enucleation speed, and hemostasis to enhance treatment outcomes for patients with benign prostatic hyperplasia.

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About the Authors

Corresponding author: Т.T. Karakotov – Ph.D. student, Institute for Urology and Human Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; e-mail: karakotov2011@yandex.ru

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