Impact of Prior Prostate Biopsy on the Outcomes of Transurethral Thulium Fiber Laser Enucleation for Benign Prostatic Hyperplasia: A Retrospective Analysis of Over 1,500 Cases

Petov V.S., Kartashov I.K., Idrisov S.N., Mursalov I.A., Krupinov E.S., Fokin I.V., Sukhanov R.B., Dymov A.M., Enikeev M.E., Amosov A.V., Krupinov G.E.

1) Institute of Urology and Human Reproductive Health, Sechenov University, Moscow, Russia; 2) Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia

Introduction: Transurethral laser enucleation of the prostate for benign prostatic hyperplasia (BPH) is considered a first-line surgical treatment for patients with prostate volume > 80 cm³. However, a significant proportion of patients undergo prostate biopsy prior to surgery due to suspected prostate cancer (PCa), which may potentially affect surgical outcomes. Objective: To evaluate the impact of prior prostate biopsy on perioperative and functional outcomes, complications of transurethral thulium fiber laser enucleation of the prostate (ThuFLEP), and the detection rate of incidental prostate cancer. Materials and Methods: A retrospective analysis was performed on 1555 patients who underwent ThuFLEP between 2020 and 2024 at the Institute of Urology and Human Reproductive Health (Sechenov University). Patients were divided into three groups: no prior biopsy (n=1265), prior transrectal biopsy (n=197), and prior combined (mpMRI/US fusion and saturation) transperineal biopsy (n=93). The analysis included perioperative parameters, functional outcomes at 6 months, incidental prostate cancer detection rate, and complication rates. Results: The groups differed significantly in PSA level (p<0.001), PSA density (p<0.001), age (p=0.018), and IPSS score (p<0.001). There were no statistically significant differences in operative time (p=0.189) or enucleated tissue weight (p=0.141). However, catheterization and hospitalization time were significantly longer in patients with prior biopsy (p<0.001). Functional outcomes at 6 months – including IPSS (p=0.397), QoL (p=0.115), Qmax (p=0.274), and post-void residual volume (p=0.248) – did not significantly differ among groups. Overall complication rates were similar, except for urethral strictures, which were more frequent in patients with prior biopsy (6.1% and 6.5% vs. 1.2%; p<0.001). Incidental PCa was more commonly detected after transrectal biopsy (11.1% vs. 5.5%; p=0.01), although most cases were clinically insignificant (ISUP grade 1). Conclusion: Prior prostate biopsy is associated with a higher risk of urethral stricture and longer catheterization and hospitalization durations, without significantly affecting functional outcomes or the rate of other complications. Incidental prostate cancer was more frequently detected after transrectal biopsy, though most cases were clinically insignificant.

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About the Authors

Corresponding Author: V.S. Petov – Urologist, PhD (Cand. Med. Sci.), Assistant Professor, Institute of Urology and Human Reproductive Health, Sechenov University, Moscow, Russia; e-mail: pettow@mail.ru

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