Current evidence of ThuLEP for BPH: A review of literature

Endoscopic enucleation of the prostate (EEP) techniques for the treatment of benign prostatic hyperplasia (BPH) have become increasingly popular among urologists over the past 23 years. Despite the energy source employed, the aim of all these procedures is to endoscopically remove the prostatic lobes by enucleating them from the prostate surgical capsule. The reasons for which EEP has gained popularity among urologists are the reduction in complications and hospital stay compared to endoscopic gold standard Transurethral Resection of the Prostate (TURP), but especially the possibility to treat large prostates, allowing to abandon open simple prostatectomy (OP) and to avoid the burden related to open surgery. Holmium laser enucleation of the prostate (HoLEP) sets the basic principles of all EEP techniques in 1998 and has become the treatment of reference for BPH. Since then, various lasers have been developed and applied to prostatic enucleation. The thulium laser has a slightly shorter wavelength compared to the holmium laser and a continuous wave output, which increase vaporization and reduce penetration depth. These features make it ideal for prostatic enucleation. A vapoenucleating technique called Thulium Laser Vapoenucleation of the Prostate was presented in 2009, followed by a blunt enucleating technique called Thulium Laser Enucleation of the Prostate in 2010. These techniques have become alternatives to HoLEP and TURP; however, the amount of literature and randomized controlled trials available are inferior compared to HoLEP. The aim of this review is to outline, describe, and discuss current evidence on thulium enucleating techniques.