Effects of Transurethral Thulium Laser Enucleation of the Prostate on Postoperative Erectile Function and Lower Urinary Tract Symptoms in Patients With Benign Prostatic Hyperplasia

Background:This prospective randomized study examined whether transurethral thulium laser enucleation of the prostate (THuLEP) provides greater early improvement in lower urinary tract symptoms than transurethral resection of the prostate (TURP) and compared secondary perioperative and functional outcomes in patients with benign prostatic hyperplasia (BPH). Material/Methods:A total of 104 patients with BPH treated from January 2021 to June 2023 were randomly assigned to TURP (n = 52) or THuLEP (n = 52).Primary outcome was 1-month postoperative between-group difference in International Prostate Symptom Score (IPSS).Secondary outcomes included perioperative parameters, quality of life (QOL), International Index of Erectile Function-5 (IIEF-5), maximum urine flow rate (Qmax), postvoid residual volume (PVR), and 30-day complications.Sex hormone levels and inflammatory biomarkers interleukin-4 (IL-4) and IL-17 were evaluated as exploratory correlates of early postoperative status.Results: At 1 month, the primary endpoint favored THuLEP: mean IPSS was 5.35 ± 0.54 in the THuLEP group and 7.65 ± 0.78 in the TURP group (unadjusted mean difference [THuLEP minus TURP], -2.30; 95% CI, -2.56 to -2.04; adjusted b = -1.24;95% CI, -1.68 to -0.80; P < 0.01).Secondary analyses showed lower blood loss, shorter catheterization duration and hospital stay, higher 1-month IIEF-5 and Qmax, lower PVR and QOL, and fewer 30-day complications with THuLEP.Exploratory biomarker analyses showed 1-month between-group differences in E2, T, T/E2, IL-4, and IL-17.These early postoperative comparisons do not establish medium-or long-term superiority. Conclusions:THuLEP produced a greater reduction in LUTS at 1 month than TURP for the prespecified primary endpoint.Several secondary perioperative and functional outcomes also favored THuLEP.Sexual-function and biomarker findings remain preliminary, requiring longer follow-up and external confirmation.