Since its introduction in 1996, laser enucleation of the prostate (LEP) has become an increasingly prominent option for managing male lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO). Despite its well-documented efficacy, the steep learning curve associated with LEP continues to limit its widespread adoption. However, in recent years, high-volume centers specializing in LEP have emerged, improving surgical proficiency and access to this technique. The present study aimed to analyze temporal changes in surgical treatment patterns for LUTS/BPO at a tertiary referral center over the past decade, focusing on the transition from transurethral resection of the prostate (TURP) to laser-based enucleation methods.
A retrospective review was conducted using data from 4,886 patients treated surgically for LUTS/BPO between 2013 and 2023 at a tertiary referral center. Patient demographics, prostate volume, and perioperative characteristics were collected and analyzed to identify evolving trends in surgical practice. The primary objective was to compare the utilization rates of TURP and LEP across the study period and evaluate associated changes in perioperative parameters and operative efficiency.
Over the ten-year observation period, the mean prostate volume treated with LEP increased by approximately 25% (from 79 cc to 99 cc), while the average prostate size managed with TURP declined by over 35% (from 48 cc to 30 cc). The proportion of patients undergoing TURP decreased nearly fivefold, from 76% in 2013 to 18% in 2023. Conversely, LEP procedures rose from 24% to 82% of all surgical interventions. Alongside this shift, operative throughput improved almost twofold, reflecting enhanced surgical efficiency and workflow-optimization over time.
Although TURP continues to serve as the benchmark surgical procedure for LUTS/BPO, this analysis demonstrates a marked transition toward laser enucleation techniques across a broad range of prostate sizes. The findings underscore the growing relevance of establishing high-volume, specialized centers dedicated to LEP, which may ensure optimal outcomes and facilitate the continued adoption of minimally invasive laser-based approaches in the surgical management of BPO.
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