pTURP vs. Laser Enucleation: Why Laser Technology May Be the Preferred Option

Palliative surgical treatment of the prostate can present several technical challenges, including increased tissue bleeding, impaired visualization of the surgical field, and the absence of a clearly defined anatomical plane for dissection.

These issues are discussed by Andrey A. Strigunov, MD, PhD, urologist at the University Clinic of Lomonosov Moscow State University.

According to Dr. Strigunov, the choice of energy source becomes particularly important in such cases. An effective surgical platform should not only provide precise tissue dissection but also ensure reliable hemostasis, which directly affects visualization and procedural safety.

Evidence from the GRAND Study

One of the largest analyses in this field to date, the GRAND Study, compared three surgical approaches in patients with prostate cancer:

• HoLEP (Holmium Laser Enucleation of the Prostate);
• ThuLEP (Thulium Laser Enucleation of the Prostate);
• TURP (Transurethral Resection of the Prostate).

The analysis included more than 221,000 procedures, comprising:

• 8,160 HoLEP procedures;
• 2,285 ThuLEP procedures;
• 211,323 TURP procedures.

According to the study results, patients treated with laser enucleation demonstrated a more favorable perioperative safety profile compared with TURP. Specifically, HoLEP and ThuLEP were associated with lower rates of:

• blood transfusion;
• intensive care unit admission;
• postoperative urinary retention;
• other perioperative complications.

The Role of Modern Laser Technologies

As Dr. Strigunov notes, modern laser systems may offer significant advantages in these procedures.

Contemporary thulium fiber lasers allow surgeons to adjust pulse duration and utilize modulated pulse modes. This flexibility enables not only classical prostate enucleation but also tissue vaporization while maintaining effective hemostasis and excellent visibility throughout the procedure.

Clinical Implications

The findings of the GRAND Study, together with current clinical experience, suggest that the choice of surgical technique and energy source can significantly influence intraoperative bleeding control, visualization quality, and perioperative outcomes during palliative prostate procedures.

For practicing urologists, these data support a more individualized approach to treatment planning, taking into account both patient characteristics and procedural objectives.

Information intended for healthcare professionals only. Contraindications apply. Please refer to the instructions for use of the medical device and consult a qualified healthcare professional before use.