{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:57:48Z","timestamp":1791374268139,"version":"4.3.1"},"reference-count":17,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","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>Objectives: We aimed to compare the observed rates of postoperative urethral stricture between patients undergoing thulium fibre laser enucleation of the prostate (ThuFLEP) using a 22 Fr miniaturised instrument strategy and those treated using a standard 26 Fr strategy. Methods: This prospective, two-centre comparative cohort study included 208 patients with benign prostatic hyperplasia and a prostate volume of less than 150 mL who underwent thulium fibre laser enucleation of the prostate (ThuFLEP) between 2024 and 2026. Patients were grouped according to the resectoscope sheath used at each centre: Group 1 comprised 99 patients treated with a 22 Fr miniaturised sheath and Group 2 comprised 109 patients treated with a standard 26 Fr sheath. The primary endpoint was the development of postoperative urethral stricture. Patient demographics and preoperative and postoperative clinical outcomes were also recorded. Results: Demographic and operative parameters were comparable between the groups. No significant difference was observed in mean prostate volumes (68.8 \u00b1 34.1 vs. 70.8 \u00b1 25.7 mL). Although the enucleation efficiency (g\/min) was numerically higher in Group 1, the difference did not reach statistical significance (2.2 \u00b1 1.1 vs. 1.8 \u00b1 0.6; p = 0.082). Postoperative urethral stricture was observed in 2 patients (2.0%) in Group 1 and in 10 patients (9.2%) in Group 2. The incidence of stricture was significantly higher in Group 2 (p = 0.036). Conclusions: The 22 Fr ThuFLEP strategy was associated with a lower observed urethral stricture rate. However, the independent effect of sheath diameter could not be separated from centre- and surgeon-related factors. Further randomised studies are required to confirm these findings.<\/jats:p>","DOI":"10.3390\/jcm15197724","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:34:31Z","timestamp":1791372871000},"page":"7724","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Urethral Stricture with a Miniaturised (22 Fr) Versus Standard (26 Fr) Resectoscope Sheath During Thulium Fibre Laser Enucleation of the Prostate: A Prospective, Two-Centre Comparative Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"\u0130brahim","family":"Buldu","sequence":"first","affiliation":[{"name":"Department of Urology, Medical Faculty, KTO Karatay University, Konya 42100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa Bilal","family":"Hamarat","sequence":"additional","affiliation":[{"name":"Department of Urology, Konya City Hospital, University of Health Sciences, Konya 42020, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4242-9134","authenticated-orcid":false,"given":"Burak","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Urology, Konya City Hospital, University of Health Sciences, Konya 42020, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taha Emre","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Urology, Konya City Hospital, University of Health Sciences, Konya 42020, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan Hakk\u0131","family":"Ta\u015fkapu","sequence":"additional","affiliation":[{"name":"Department of Urology, Medical Faculty, Necmettin Erbakan University, Konya 42080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1159\/000019535","article-title":"Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: Preliminary results","volume":"33","author":"Fraundorfer","year":"1998","journal-title":"Eur. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.urology.2023.05.013","article-title":"Pulsed-wave vs continuous-wave thulium fiber laser enucleation of the prostate (ThuFLEP): A comparison of perioperative outcomes","volume":"178","author":"Perri","year":"2023","journal-title":"Urology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1007\/s00345-026-06363-8","article-title":"Performance and safety of Thulium fibre laser enucleation of the prostate (ThuFLEP): A comparative study over small, average and large prostate","volume":"44","author":"Barriol","year":"2026","journal-title":"World J. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1089\/end.2019.0630","article-title":"Retrospective assessment of endoscopic enucleation of prostate complications: A single-center experience of more than 1400 patients","volume":"34","author":"Morozov","year":"2020","journal-title":"J. Endourol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s12262-012-0549-x","article-title":"The size of external urethral meatus on maximum stretch in Indian adult males","volume":"76","author":"Bhat","year":"2014","journal-title":"Indian J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"151","DOI":"10.5173\/ceju.2024.0255","article-title":"Does miniaturisation improve holmium laser enucleation of prostate outcomes? A meta-analysis of comparative studies","volume":"78","author":"Adhoni","year":"2025","journal-title":"Cent. Eur. J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1089\/end.2020.0350","article-title":"Urethral complications while using 26F vs 28F resectoscope sheaths in holmium laser enucleation of the prostate: A retrospective observational study","volume":"35","author":"Thai","year":"2021","journal-title":"J. Endourol."},{"key":"ref_8","unstructured":"Lumen, N., and Campos-Juanatey, F. (2023). Section 3: Definition, epidemiology, aetiology and prevention. EAU Guidelines on Urethral Strictures, European Association of Urology. Available online: https:\/\/uroweb.org\/guidelines\/archive\/urethral-strictures."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1007\/s00345-022-03946-z","article-title":"Urethral stricture following endoscopic prostate surgery: A systematic review and meta-analysis of prospective, randomized trials","volume":"40","author":"Pirola","year":"2022","journal-title":"World J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1590\/S1677-5538.IBJU.2014.0093","article-title":"Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection?","volume":"41","author":"Keles","year":"2015","journal-title":"Int. Braz. J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s00345-026-06204-8","article-title":"Does size matter? Comparison of miniaturized (22 Fr) versus standard (26 Fr) instruments in pulsed thulium:YAG laser enucleation of the prostate","volume":"44","author":"Ozsoy","year":"2026","journal-title":"World J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1089\/end.2023.0383","article-title":"Does resectoscope sheath size influence holmium laser enucleation of the prostate outcomes? A prospective randomized controlled trial","volume":"37","author":"Dean","year":"2023","journal-title":"J. Endourol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100146","DOI":"10.1016\/j.urolvj.2022.100146","article-title":"Minimally invasive laser enucleation of the prostate (MiLEP): Slim (22Ch) and Ultra Slim (18.5Ch) HoLEP","volume":"14","author":"Teloken","year":"2022","journal-title":"Urol. Video J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1089\/end.2022.0422","article-title":"Urethral complications post-holmium laser enucleation of the prostate: A seven-year experience","volume":"36","author":"Elsaqa","year":"2022","journal-title":"J. Endourol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Hou, C.P., and Wu, J.H. (2024). Urethral strictures after endoscopic enucleation of the prostate and its associated clinical outcomes in aging men. Medicina, 60.","DOI":"10.3390\/medicina60111771"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Golomb, D., and Atias, M. (2025). Incidence and predictors of urethral stricture following transurethral resection of the prostate and open simple prostatectomy: A 21-year retrospective cohort study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14113777"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/03915603261440245","article-title":"Miniaturized laser enucleation of the prostate (MiLEP) is feasible and safe: 12-month follow-up, real-life, prospective multicenter study","volume":"93","author":"Cindolo","year":"2026","journal-title":"Urologia"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7724\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:43:55Z","timestamp":1791373435000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":17,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197724"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197724","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}