Thulium laser enucleation of the prostate (ThuLEP)

What thulium lasers do

Two related thulium devices are used for enlarged-prostate surgery.

• Thulium:YAG laser (Tm:YAG) - a continuous-wave laser emitting around 2,013 nm. Used in thulium laser enucleation of the prostate (ThuLEP) and thulium laser vaporesection.
• Thulium fibre laser (TFL) - a newer, pulsed fibre-laser platform emitting around 1,940 nm. Its wavelength is very strongly absorbed by water, so cutting and vaporisation are highly efficient with a short thermal depth.

Both wavelengths can be used to develop the anatomical plane between the prostatic adenoma and the capsule and so perform an enucleation equivalent to HoLEP. The obstructing tissue is morcellated and sent for pathology in the same way.

How it compares with HoLEP

Published randomised and systematic-review evidence comparing ThuLEP with HoLEP suggests broadly similar results for:

• Symptom scores (IPSS).
• Peak urinary flow rate (Qmax).
• Catheter time and hospital stay.
• Rates of bleeding, incontinence and retreatment.

The main practical differences:

• HoLEP has a longer and more extensive published track record, including 10-year durability data.
• Thulium:YAG cuts a little more smoothly than pulsed holmium, which some surgeons report as an advantage during enucleation.
• The thulium fibre laser is a newer platform; availability varies by hospital.

Availability in Sydney

HoLEP remains the primary high-volume laser enucleation procedure at St Vincent's Private and Mater Hospital North Sydney. ThuLEP and thulium fibre laser enucleation are discussed case by case when they are a clinically relevant option.

Who might consider a thulium-based procedure

• Patients in research settings or at centres that routinely offer ThuLEP.
• Patients who have already been advised that a thulium platform is available at their treating hospital.
• Patients who are otherwise HoLEP candidates but want to understand the full laser-enucleation landscape before deciding.

For most men in Sydney the practical choice is HoLEP (for gland size, blood thinners or durability) or GreenLight (for smaller glands and same-day discharge). Thulium-based enucleation is a reasonable alternative where available and the priorities are the same as for HoLEP.