Thulium laser transurethral incision of the prostate with ejaculation-sparing intent: 2-year follow-up outcomes from a high-volume centre

Introduction Several 'ultra-minimally-invasive' surgical treatments (uMISTs) have been developed, aiming to relieve benign prostatic obstruction (BPO) and spare ejaculatory function; however, such techniques do not always ensure substantial improvements in uroflowmetry parameters. The aim of the present study was to evaluate the 2 -year functional outcomes of thulium laser transurethral incision of the prostate (ThuIP) as an alternative to uMISTs. Material and methods Data of consecutive patients affected by BPO with indication to surgical intervention and a strong will to spare ejaculatory function were collected on a dedicated prospectively maintained database. A specific "trifecta" was identified as the contemporary presence of: (1) postoperative Qmax >= 15 ml/s; (2) absence of early (within 90 days) complications; and (3) preserved antegrade ejaculation. Results 120 patients underwent ThuIP and were analysed. Median catheterisation time was 2 days (IQR 2-2). Significant improvements in IPSS and IPSS-QoL scores and uroflowmetry parameters were observed at all follow-up times. At the last follow-up visit (24 months) the median Delta IPSS was -12 (-17; -9), median Delta IPSS-QoL was -3 (-4; -2), median Delta Qmax was +7.7 ml/s (+5.2; +11.0), and median Delta PVR was -50 ml (-100; 0) (all p -values <0.001). Fourteen patients reported postoperative absence of antegrade ejaculation (11.7%). Overall, trifecta was achieved in 86 patients (71.7%) at 6 months, in 79 patients (65.8%) at 12 months, and in 75 patients (62.5%) at 24 months. Conclusions ThuIP allows for a significant improvement in uroflowmetry parameters and patient-reported outcomes at 2 -year follow-up. Moreover, antegrade ejaculation is preserved in approximately 90% of cases.