Comparative analysis of thulium fiber laser enucleation of the prostate (ThuFLEP) and holmium laser enucleation of the prostate (HoLEP) in the management of benign prostatic hyperplasia: A systematic review and meta-analysis

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Abstract
Objective: To systematically compare thulium fiber laser enucleation of the prostate (ThuFLEP) with holmium laser enucleation of the prostate (HoLEP) in terms of efficacy, safety, and perioperative outcomes in men undergoing surgical treatment for benign prostatic hyperplasia (BPH). Materials and methods: This systematic review and meta-analysis was conducted according to the PRISMA 2020 guidelines and registered in PROSPERO (CRD420251057100). PubMed, Scopus, Web of Science, EMBASE, and Google Scholar were searched up to March 2025 for randomized controlled trials and comparative observational studies that evaluated ThuFLEP versus HoLEP. The primary outcomes were perioperative parameters (operative time, catheterization duration, and length of hospital stay) and functional outcomes (International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax)). Secondary outcomes included blood loss, transfusion rate, and postoperative complications graded using the Clavien–Dindo classification. Results: Twelve studies comprising 1248 patients (624 ThuFLEP and 624 HoLEP) met the inclusion criteria. Both techniques yielded comparable functional improvements, with no meaningful differences in the postoperative IPSS, Qmax, or post-void residual volume. ThuFLEP showed perioperative advantages, including a shorter operative time (mean difference (MD) −12.4 min; 95% CI −20.1 to −4.7), shorter catheterization duration (MD −0.58 days; 95% CI −0.81 to −0.35), and shorter hospital stay (MD −0.73 days; 95% CI −1.02 to −0.44). Bleeding-related outcomes favored ThuFLEP, with lower estimated blood loss and fewer transfusions. Overall postoperative complication rates and high-grade complications (Clavien–Dindo ⩾ III) were similar between the groups. Conclusions: ThuFLEP provides functional outcomes equivalent to those of HoLEP while offering improved perioperative efficiency and favorable bleeding-related outcomes. Both procedures appear to be safe and effective for treating BPH. Further large multicenter randomized trials with long-term follow-up are needed to confirm durability and evaluate cost-effectiveness.

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