{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:16:59Z","timestamp":1788171419510,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive surgery for BPH. Thulium-based techniques (ThuLEP\/ThuFLEP) are increasingly used for their cutting\/coagulation benefits, but their comparative outcomes versus HoLEP remain uncertain. Methods: Our synthesis relied solely on RCT data comparing ThuLEP\/ThuFLEP versus HoLEP for BPH. Eligible studies were RCTs directly comparing ThuLEP or ThuFLEP with HoLEP. Results: Eight RCTs involving 1196 patients were included. Compared with HoLEP, thulium laser enucleation demonstrated similar perioperative outcomes, with no statistically significant differences observed in operative time, enucleated tissue weight, hospital stay, or catheterization time. Postoperative hemoglobin decrease was comparable between the two groups (MD \u22120.34, 95% CI \u22120.69 to 0.01, p = 0.05). Subgroup analyses indicated that ThuLEP might be associated with potential advantages in postoperative hemoglobin decrease and transient urinary incontinence; however, these findings require cautious interpretation due to limited sample sizes and heterogeneity among studies. No significant differences were identified in postoperative complications or functional recovery outcomes. Conclusions: Current evidence from RCTs indicates that thulium laser enucleation techniques and HoLEP provide similar efficacy and safety outcomes for patients undergoing surgical treatment of BPH.<\/jats:p>","DOI":"10.3390\/jcm15176661","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:21:19Z","timestamp":1788168079000},"page":"6661","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Effectiveness and Safety of Thulium Laser Enucleation and Holmium Laser Enucleation for BPH: Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"15","author":[{"given":"Yuan","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Urology, The People\u2019s Hospital of Tongnan District Chongqing City, Chongqing 402660, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Urology, Bishan Hospital of Chongqing Medical University, Chongqing 402760, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Urology, Bishan Hospital of Chongqing Medical University, Chongqing 402760, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changjian","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Urology, Bishan Hospital of Chongqing Medical University, Chongqing 402760, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/JU.0000000000002183","article-title":"Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline Part I\u2014Initial work-up and medical management","volume":"206","author":"Lerner","year":"2021","journal-title":"J. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.eururo.2014.11.006","article-title":"Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: Population-based cohort study","volume":"68","author":"Cindolo","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.eururo.2014.01.010","article-title":"Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: A randomized noninferiority controlled trial with long-term results at 6 years","volume":"66","author":"Chen","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s00120-009-2183-1","article-title":"Benign prostatic hyperplasia (BPH): Surgical therapy options","volume":"49","author":"Reich","year":"2010","journal-title":"Urol. A"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.eururo.2014.06.017","article-title":"A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update","volume":"67","author":"Cornu","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.urology.2012.08.069","article-title":"Thulium laser enucleation versus plasmakinetic resection of the prostate: A randomized prospective trial with 18-month follow-up","volume":"81","author":"Yang","year":"2013","journal-title":"Urology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range and\/or mid-quartile range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat. Methods Med. Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_12","first-page":"491","article-title":"Prospective randomized multicenter study to evaluate holmium vs. new thulium fiber laser for prostate enucleation","volume":"76","author":"Manfredi","year":"2024","journal-title":"Minerva Urol. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s00345-023-04748-7","article-title":"Thulium fiber laser vs. holmium laser enucleation of the prostate: Results of a prospective randomized non-inferiority trial","volume":"42","author":"Kosiba","year":"2024","journal-title":"World J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1111\/bju.16174","article-title":"A randomized trial of holmium laser vs thulium laser vs bipolar enucleation of large prostate glands","volume":"132","author":"Shoma","year":"2023","journal-title":"BJU Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1007\/s00345-022-04046-8","article-title":"Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP","volume":"40","author":"Enikeev","year":"2022","journal-title":"World J. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1007\/s00345-020-03468-6","article-title":"A prospective multicenter randomized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enucleation of the Prostate (ThuLEP\/ThuFLEP)","volume":"39","author":"Bozzini","year":"2021","journal-title":"World J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s00345-019-02945-x","article-title":"Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results","volume":"38","author":"Zhang","year":"2020","journal-title":"World J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1007\/s00345-018-2321-8","article-title":"Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: Preliminary 6-month safety and efficacy results of a prospective randomized trial","volume":"36","author":"Becker","year":"2018","journal-title":"World J. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.urology.2011.12.018","article-title":"Thulium laser versus holmium laser transurethral enucleation of the prostate: 18-month follow-up data of a single center","volume":"79","author":"Zhang","year":"2012","journal-title":"Urology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s10353-018-0551-z","article-title":"Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients","volume":"50","author":"Bolliger","year":"2018","journal-title":"Eur. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1089\/end.1998.12.457","article-title":"Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: An update on the early clinical experience","volume":"12","author":"Gilling","year":"1998","journal-title":"J. Endourol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/j.1464-410X.2010.09954.x","article-title":"Critical review of lasers in benign prostatic hyperplasia (BPH)","volume":"107","author":"Gravas","year":"2011","journal-title":"BJU Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.eururo.2012.01.010","article-title":"EAU Guidelines Panel on Lasers, Technologies. EAU guidelines on laser technologies","volume":"61","author":"Herrmann","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/bju.15921","article-title":"Thulium fibre laser vs holmium: Yttrium-aluminium-garnet laser lithotripsy for urolithiasis: Meta-analysis of clinical studies","volume":"131","author":"Chua","year":"2023","journal-title":"BJU Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1038\/s41391-019-0135-4","article-title":"Efficacy and safety of enucleation vs. resection of prostate for treatment of benign prostatic hyperplasia: A meta-analysis of randomized controlled trials","volume":"22","author":"Zhang","year":"2019","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.asjsur.2021.07.045","article-title":"Comparison of enucleation between thulium laser and holmium laser for benign prostatic hyperplasia: A systematic review and meta-analysis","volume":"45","author":"Meng","year":"2022","journal-title":"Asian J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.euf.2021.03.024","article-title":"Holmium Versus Thulium Laser Enucleation of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"8","author":"Hartung","year":"2022","journal-title":"Eur. Urol. Focus."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s00345-015-1639-8","article-title":"Holmium laser enucleation of the prostate for treatment for large-sized benign prostate hyperplasia; is it a realistic endourologic alternative in developing country?","volume":"34","author":"Elshal","year":"2016","journal-title":"World J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.juro.2016.11.001","article-title":"Prospective Assessment of Learning Curve of Holmium Laser Enucleation of the Prostate for Treatment of Benign Prostatic Hyperplasia Using a Multidimensional Approach","volume":"197","author":"Elshal","year":"2017","journal-title":"J. Urol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1590\/s1677-5538.ibju.2024.0039","article-title":"Long-term functional outcomes and surgical retreatment after thulium laser enucleation of the prostate: A 10-year follow-up study","volume":"50","author":"Manfredi","year":"2024","journal-title":"Int. Braz. J. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1016\/j.euf.2021.12.006","article-title":"Long-term Reinterventions after Thulium Laser Enucleation of the Prostate: 12-Year Experience with more than 1000 Patients","volume":"8","author":"Siegel","year":"2022","journal-title":"Eur. Urol. Focus."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6661\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:37:28Z","timestamp":1788169048000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6661"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":31,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176661"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176661","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]}}}