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Surgical approaches for benign prostatic hyperplasia have evolved and diversified over the past decades. While numerous studies document the efficacy of surgical procedures for moderate prostate sizes, there remains insufficient data for large prostate volumes >200 ml, leaving important questions unanswered regarding their effectiveness and safety. Consequently, selecting and adapting suitable therapeutic options for this specific patient group often poses a significant challenge. In this context, this review comprehensively summarizes and discusses current insights into surgical treatment options for large prostate volumes (>200 ml) following an extensive literature review.In summary, the surgical treatment of prostate volumes >200 ml is a challenge regardless of the chosen surgical method. Minimally invasive approaches should be considered standard practice today. Anatomical endoscopic enucleation of the prostate is a size-independent method and has the lowest morbidity. As it may be performed in spinal anaesthesia, endoscopic enucleation is feasible in patients with an increased anaesthetic risk. In extremely large prostate glands, the procedure poses challenges even for highly experienced surgeons. Especially in obese patients, the surgeon should be familiar with different exit strategies. Robot-assisted simple prostatectomy provides a minimally invasive alternative that may also treat pathologies such as diverticula or large bladder stones in the same surgical session. Due to its transabdominal approach, the morbidity and anaesthetic risk is comparatively higher. Each centre and surgeon should individually decide in which method they have the greatest expertise and which option is best suited for the specific case. In cases of limited expertise, it is advisable to refer patients to a centre with appropriate specialization., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Due to demographic changes in today's society, the number of patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) is increasing. Similarly, the proportion of patients with cardiovascular risk factors undergoing antiplatelet (AP) or anticoagulation (AC) therapy is growing as well., Methods: This review discusses the current literature on various techniques used for anatomic endoscopic enucleation of the prostate (AEEP) in patients on AC/AP therapy., Results: The large number of energy sources used for AEEP makes it difficult to compare them. Overall, fewer bleeding-associated complications arise in patients under AP compared to AC or bridging therapy with low molecular weight heparin. However, perioperatively both AP and AC therapy lead to a higher risk of bleeding complications compared to patients not taking anticoagulants., Conclusions: The literature shows that AEEP is possible and efficacious in patients under AC/AP therapy, with only slight differences compared to patients not taking AC/AP drugs, on a short and long-term basis. Nevertheless, the sparse data, the retrospective nature of many studies and the inclusion of prostate sizes between 50 and 110 ml only, make it difficult to come to strong conclusions., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To summarize the current evidence and the reasons to go for thulium-based anatomical endoscopic enucleation of the prostate (AEEP)., Methods: This review discusses the available literature on thulium-based AEEP., Results: Thulium lasers operate at a wavelength between 1940 and 2013 nm. This wavelength, which has a low penetration depth in water, allows to perform smooth cuts in the prostatic tissue and allows urologists to perform various procedures: resection, vaporization, enucleation, or vapoenucleation of the prostate. Depending on the type of thulium laser, it can be used either in a continuous, or pulsed mode., Conclusion: In recent years, an increasing amount of evidence has described the thulium laser as a minimally invasive and size-independent treatment option for benign prostatic enlargement with excellent long-term results., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Bladder neck stenosis (BNS) after simple prostatectomy and vesicourethral anastomosis stenosis (VUAS) after radical prostatectomy for prostate cancer are common sequelae. However, the two entities differ in their pathology, anatomy and their surgical results. VUAS has an incidence of 0.2-28%. Commonly, VUAS occurs within the first 2 years after surgery. Initial therapy should be performed endourologically: dilatation, (laser) incision or resection. After three unsuccessful treatment attempts, open reconstruction should be considered. Different surgical approaches (abdominal, perineal, abdominoperineal) have been described. All are associated with good success rates. However, they are accompanied by high rates of urinary incontinence. Incontinence can be treated safely by implantation of an artificial urinary sphincter. The incidence of BNS is around 5% for all types of surgery for benign prostate hyperplasia. It occurs within the first 2 years after surgery. Initial treatment should be performed endourologically. In case of recalcitrant BNS, open reconstruction is indicated. The YV-plasty is an established procedure, and the T‑plasty represents a modification. Success rates of both procedures are high. Robot-assisted reconstructive procedures have been described for both VUAS and BNS.

Introduction: To evaluate the intermediate-term outcomes of thulium vapoenucleation of the prostate (ThuVEP) and thulium vaporesection of the prostate (ThuVaRP) in patients with benign prostate obstruction (BPO)., Materials and Methods: A bicentric retrospective matched-paired comparison of patients treated by ThuVEP (n = 80) or ThuVaRP (n = 80) was performed. The patients were preoperatively assessed with International Prostate Symptom Score (IPSS), quality of life (QoL), post-void residual urine (PVR), maximum urinary flow rate (Qmax), prostatespecific antigen (PSA) and re-evaluated at 12- and 24-month follow-up., Results: Median prostate volume was 65 mL and not different between the groups. The immediate re-operation rate was significantly different between ThuVEP and ThuVaRP (5 vs. 0%, p ≤ 0.0434). IPSS, QoL, Qmax and PVR had improved significantly compared to preoperative assessment in both groups at 12- and 24-month follow-up (p ≤ 0.001). Median Qmax (18.2 vs. 21.0 mL/s) and PVR (29.4 vs. 0 mL) were significantly different between ThuVEP and ThuVaRP at 24-month follow-up (p ≤ 0.001), while IPSS and QoL showed no differences between the groups. However, the PSA reduction was significantly higher after ThuVEP compared to ThuVaRP (78.93 vs. 23.39%, p ≤ 0.006) at 24-month follow-up., Conclusions: ThuVEP and ThuVaRP are safe and efficacious procedures for patients with BPO. Although the peri-operative re-intervention rates were lower after ThuVaRP, the low PSA reduction rate after ThuVaRP at 24-month follow-up favours the ThuVEP procedure., (© 2017 S. Karger AG, Basel.)

Introduction and Objectives: To compare the perioperative outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO)., Methods: Forty-eight and 46 patients were prospectively randomized to ThuVEP and HoLEP. All patients were assessed preoperatively and 4-week postoperatively. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%)., Results: Median age at surgery was 73 (67-76) years and median prostate volume was 80 (46.75-100) cc and not different between the groups (p = 0.207). The median operative time was 60 (41-79) minutes without significant differences between both groups (p = 0.275). There were no significant differences between the groups regarding catheterization time [2 (2-2) days, p = 0.966] and postoperative stay [2 (2-3) days, p = 0.80]). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was higher after HoLEP compared to ThuVEP (15.2 vs. 2.1%, p ≤ 0.022). At 1-month follow-up, peak urinary flow rates (10.7 vs. 22 ml/s), post-void residual volumes (100 vs. 20 ml), International Prostate Symptom Score (20 vs. 10) and Quality of Life (4 vs. 3) had improved significantly (p ≤ 0.005) without significant differences between the groups., Conclusions: ThuVEP and HoLEP are safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.

Purpose: TUR-prostate (TUR-P) is considered the reference method for surgical treatment of benign prostatic obstruction (BPO); Greenlight laser photoselective vaporization (PVP) and thulium laser vapoenucleation (ThuVEP) have also been established as treatments of BPO. Objective of this prospective observation was to compare a large numbers of patients treated in everyday routine., Methods: This prospective multicentre data collection assesses morbidity and perioperative course of consecutive men treated with BPO-related transurethral surgery between 2011 and 2014 in a German metropolis area with TUR-P, PVP or ThuVEP., Results: Two thousand six hundred and forty-eight patients have been treated in the time period. All treatment options achieved immediate improvement of voiding parameters. Multivariate analyses proved shorter hospital stay after laser treatments as compared to resection (p < 0.001). In terms of hospital stay, the advantage of ThuVEP compared to TUR-P increased with prostate volume (p < 0.001). Patients with ongoing anticoagulation or bridging had prolonged hospital stay (p < 0.001). Overall adverse events were least frequent in PVP (p 0.016), as were Clavien 3b events (p < 0.001)., Conclusions: Surgical treatment of BPO is effective and safe independent of the surgical procedure. Volume reduction is most effective in ThuVEP; PVP has the lowest rate of severe complications. Laser treatment is associated with shorter hospital stay. Surgery under ongoing anticoagulation prolonged the post-operative hospital stay.

Introduction: To evaluate the short-term results of thulium vaporesection of the prostate (ThuVEP) and thulium vapoenucleation of the prostate (ThuVARP) in patients with benign prostatic obstruction on oral anticoagulants (OA)., Methods: A 3-centre retrospective matched-paired comparison of patients treated by ThuVEP (n = 26) or ThuVARP (n = 26) was performed. Thirty-four patients were on aspirin/ticlopidin, 7 on clopidogrel or clopidogrel and aspirin, and 11 on phenprocoumon at the time of surgery., Results: Haemoglobin decrease was higher after ThuVEP compared to ThuVARP (1.5 vs. 0.3 g/dl, p < 0.001). The rate of postoperative blood transfusions (3.9 vs. 0%), clot retention (3.9 vs. 0%), and re-operation (7.7 vs. 0%) was not different between ThuVEP and ThuVARP (p = 0.274). Catheterization time was shorter for ThuVARP (1 vs. 2 days, p < 0.01). Qmax was significantly higher after ThuVEP at 6-month follow-up (31 vs. 21.5 ml/s, p < 0.001), while improvements in International Prostate Symptom Score, quality of life, and post-voiding residual urine showed no differences between the groups. Urethral or bladder neck strictures did not occur during the 6-month follow-up in both groups., Conclusions: ThuVEP and ThuVARP are safe and efficacious procedures in patients on OA. Although patients assigned to ThuVEP had higher Qmax at 6-month follow-up, ThuVARP resulted in similar functional outcomes., (© 2015 S. Karger AG, Basel.)

Background: Numerous studies have shown that thulium vapoenucleation of the prostate (ThuVEP) is a size-independent minimally invasive procedure for the treatment of benign prostatic enlargement. All ThuVEP series have been performed with a 2-µm thulium laser device so far. The aim of this study was to evaluate the complications and early postoperative results of two thulium-devices with different wavelengths for ThuVEP in prostates larger than 80 ml., Materials and Methods: A retrospective bi-centric matched-paired analysis with 296 patients was performed. Based on prostate size, 148 were matched at each centre and laser device, respectively. A 2-µm (RevoLix, LISA Laser products, Katlenburg, Germany n=148) and a 1.9-µm (vela XL, starmedtec, Starnberg, Germany, n=148) thulium laser with a power output of 90 and 80 W was used. Patients' data were assessed and compared., Results: The median prostate volume (interquartile) was 100 ml (range 86.25-120 ml). At discharge, Qmax (preoperative 7.9 and 9 ml/s vs. postoperative 19.35 and 16.2 ml/s) and postvoiding-residual urine (preoperative 130 and 45 ml vs. postoperative 20 and 25 ml) were significantly improved after 2-µm and 1.9-µm ThuVEP (p<0.001). The median catheterization time and hospitalization times were 2 and 4 days in both groups. Perioperative complications occurred in 89 patients (30.1%): Clavien 1 (12.2%), Clavien 2 (9.1%), Clavien 3a (0.7%), Clavien 3b (7.1%), and Clavien 4a (1%). Regarding the occurrence of complications, there were no differences between the two thulium devices., Conclusion: ThuVEP represents a safe and effective treatment for prostates larger than 80 ml. Both thulium laser devices give satisfactory immediate micturition improvement with low perioperative morbidity.

Introduction: To evaluate the current role of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of benign prostatic obstruction (BPO)., Methods: A Medline search for randomized trials, case series, and comparative studies being published since the initial description of the ThuVEP procedure (2009-2014) was performed to assess the safety, the perioperative morbidity, the efficacy, and the durability of the technique., Results: A total of 14 peer-reviewed original articles, seven case series [level of evidence (LOE) 4] and seven comparative studies (LOE 3b), have been identified. ThuVEP has been shown to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO in large, prospective, and retrospective series (LOE 4/3b). The feasibility and safety of the ThuVEP procedure has also been confirmed in patients at high cardiopulmonary risk on oral anticoagulants (LOE 4). It has also been demonstrated that the erectile function is not impaired by the ThuVEP procedure (LOE 4). However, published ThuVEP series are from very few centers of excellence not exceeding a LOE of 3b. Randomized controlled trials comparing ThuVEP with standard procedures for the treatment of BPO, namely transurethral resection of the prostate, open prostatectomy, or holmium laser enucleation of the prostate, have not been published so far., Conclusions: ThuVEP appears to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO (LOE 4/3b). Multicentric PRT are however needed to define the current role of ThuVEP in the armamentarium of minimally invasive transurethral surgery of the prostate.

Introduction: To evaluate Thulium VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) with long-term follow-up., Methods: A prospective analysis of 124 patients who underwent ThuVEP between January 2007 and July 2008 at our institution was done. ThuVEP was carried out using the 70-Watt 2-μm continuous wave Tm:YAG laser. Patient demographic, perioperative complications, and follow-up data were analysed., Results: The median (interquartile range) preoperative prostate volume was 58.5 (45-70.75) cc. The median operation and enucleation time were 74 (60-100) and 32.54 (25.62-37.52) min, respectively. The median catheter time and postoperative hospital stay were 2 (2-2) and 4 (3-5) days, respectively. Nine (7.3 %) patients required a second-look operation in the immediate postoperative course (failed morcellation = 2, clot retention = 3, and residual adenoma = 4). Two patients needed blood transfusions (1.6 %) postoperatively. At 12-month follow-up, International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoiding residual urine (PVR) improved significantly in comparison with preoperative assessment (p < 0.001). A significant decrease of median PSA (4.7 vs. 0.92 μg/l) was seen at one-year follow-up (p < 0.001). At the 48-month follow-up mark, Qmax, PVR, IPSS, and QoL still differed significantly from baseline (p < 0.001). Bladder neck contractures and urethral strictures each developed in 1.6 and 0.8 % of the patients during follow-up. None of the patients were re-treated during follow-up for recurrent prostatic tissue., Conclusions: ThuVEP is a safe, efficacious, and durable procedure for the treatment of BPO. The incidence of late complications with ThuVEP was low.

Introduction: To evaluate the safety and efficacy of Thulium VapoEnucleation of the prostate (ThuVEP) for patients on oral anticoagulants (OA) with symptomatic benign prostatic obstruction (BPO)., Methods: Fifty-six patients, undergoing ThuVEP at two institutions, were evaluated from May 2009 until June 2011. All patients were at high cardiopulmonary risk and presented with a median American Society of Anesthesiology score of 3 [interquartile range (IQR) 2-3]. Thirty-two patients were on aspirin, 8 were on clopidogrel or clopidogrel and aspirin, and 16 on phenprocoumon at the time of surgery. Patient demographic, perioperative, and follow-up data were analyzed., Results: Median prostate volume was 50 (IQR 34-76) cc, and resected tissue weight was 32 (IQR 20-50) g. The median operative time was 61.5 (IQR 40-100.75) min, and the catheter time 2 (IQR 2-3) days. There were no perioperative thromboembolic events. Five patients (8.9%) required a second-look operation in the immediate postoperative course (hemorrhage n = 4, residual adenoma n = 1) and four (7.1%) blood transfusions. Complications within the first 30 days included urinary tract infections (1.7%), urinary retention (3.6%), and delayed bleeding (7.1%). These complications were managed conservatively. At 12-month follow-up, median QoL [5 (IQR 3.75-5) vs. 1 (IQR 1-2)], IPSS [21.5 (IQR 15.5-23.75) vs. 5 (IQR 3-8)], Qmax [7.7 (IQR 6.3-10) vs. 28.3 (IQR 21.25-39.2) ml/s], and postvoiding residual urine [100 (IQR 46-200) vs. 17.5 (IQR 0-36) ml] improved significantly (p < 0.002)., Conclusions: Thulium VapoEnucleation of the prostate seems to be a safe and efficacious procedure for the treatment of symptomatic BPO in patients at high cardiopulmonary risk on OA.

Background: Thulium vapoenucleation of the prostate (ThuVEP) has been introduced as a minimally invasive treatment for benign prostatic obstruction (BPO)., Objective: To analyze immediate outcomes and the institutional learning curve of ThuVEP, and to report its standardized complication rates, using the modified Clavien classification system (CCS) to grade perioperative complication rates., Design, Settings, and Participants: A prospective evaluation of 1080 patients undergoing ThuVEP from January 2007 until May 2012 at our institution., Intervention: ThuVEP was performed using the 2-μm, continuous-wave, thulium:yttrium-aluminum-garnet laser., Outcome Measurements and Statistical Analysis: Preoperative status, surgical details, and immediate outcome were recorded for each patient. Perioperative complications were classified according to the modified CCS., Results and Limitations: Median prostate size was 51 ml (interquartile range [IQR]: 36-78.7). Median operation time was 56 min (IQR: 40-80), and median enucleation time was 32.5 min (IQR: 22-50). Median catheterization time was 2 d (IQR: 2-2); median length of hospital stay was 4 d (IQR: 3-5). Median resected tissue weight was 30 g (IQR: 16.00-51.25). Incidental carcinoma of the prostate was detected in 59 (5.5%) patients. Median maximum urinary flow rate (8.9 vs 18.4 ml/s) and postvoid residual urine volume (120 vs 20 ml) changed significantly (p<0.001). Minor complications occurred in 24.6% of the patients (Clavien 1: 20.8%; Clavien 2: 3.8%). Early reinterventions were necessary in 6.6% of the patients (Clavien 3a: 0.6%; Clavien 3b: 6%). One Clavien 4 complication occurred (0.09%). The overall complication rates decreased significantly over time due to decreasing Clavien 1, 2, and 3b events. The major limitations of the study are the prospective, unicentric study design, the lack of a control group, and that only short-term data were documented on morbidity and efficacy of the ThuVEP procedure., Conclusions: ThuVEP is a safe and effective procedure for the treatment of symptomatic BPO, with low perioperative morbidity., (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Purpose: Tm:YAG vapoenucleation was introduced as a minimally invasive treatment in patients with benign prostatic obstruction. The efficiency and safety of Tm:YAG vapoenucleation must still be confirmed in large volume prostates to prove the size independence of this promising treatment option. We evaluated the safety and efficiency of Tm:YAG vapoenucleation in patients with a prostate volume of 80 cc or greater and benign prostatic obstruction during a 12-month followup., Materials and Methods: Included in this trial were 90 consecutive patients undergoing 90 W Tm:YAG vapoenucleation. Vapoenucleation was done using the 2 μm continuous wave Tm:YAG laser combined with a mechanical tissue morcellator. We analyzed patient demographic, perioperative and 12-month followup data. Complications were assessed., Results: Mean preoperative prostate volume was 108.6 cc (range 80 to 200), mean International Prostate Symptom Score was 23.5 (range 8 to 35) and mean quality of life score was 4.3 (range 1 to 6). There was an 86% reduction (range 67% to 99%) in prostate volume on transrectal ultrasound by 12 months and an 88% decrease (range 58% to 100%) in prostate specific antigen. International Index of Erectile Function score remained stable. Peak urinary flow rate, International Prostate Symptom Score and quality of life improved significantly (p <0.001), as did post-void residual urine. The overall complication rate was manageable. Two patients required blood transfusion and 10 experienced early postoperative stress incontinence. During followup 7% of patients had symptomatic urinary tract infection and 2 had persistent grade I stress urinary incontinence. The reoperation rate due to urethral stricture was 1.8% during the 12-month followup., Conclusions: Tm:YAG vapoenucleation is a safe, effective and size independent treatment option for benign prostatic obstruction. As shown by reductions in transrectal ultrasound prostate volume and prostate specific antigen, complete removal of the adenoma can be achieved by this procedure., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Transurethral resection of the prostate and open prostatectomy have been the standard of care for the surgical treatment of benign prostatic obstruction (BPO) over decades. New emerging techniques for the surgical management of BPO have been currently introduced, but might be associated with new, unusual complications. Methods: We herewith report on two patients with a rectal perforation after aquablation treatment of BPO. Results: In the first case, the diagnosis was made 2 days after the aquablation procedure due to unspecific postoperative symptoms. A complex combined open/endoscopic repair of the defect was carried out thereafter. As a consequence, a rectoscopy was routinely performed since then following each aquablation procedure. In the second case, intraoperative rectoscopy after uneventful aquablation revealed the rectal perforation. The perforation was clipped immediately with an over the scope-clip by colonoscopy. Conclusions: These two cases of a rectal perforation after aquablation of the prostate demonstrate an unusual complication and its complex management. Diagnostic delay complicates its treatment. Therefore, immediate rectoscopy should be performed routinely after the aquablation procedure. [ABSTRACT FROM AUTHOR]

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Purpose: To analyze the 12-month outcomes of low-powered holmium laser enucleation of the prostate (LP-HoLEP) for patients with symptomatic benign prostatic obstruction (BPO). Methods: A total of 54 patients with symptomatic BPO were treated with LP-HoLEP. All patients were treated by two experienced LP-HoLEP surgeons. A 50-W Ho:YAG laser was used at 39.6-W (2.2 J, 18 Hz). All patients were assessed preoperatively by International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), post-void residual urine (PVR), PSA, and whole prostate volume measurement by transrectal ultrasound. The patients were reassessed at 1-, 6-, and 12-month follow-up. The complications were classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%). Results: The median age was 72.5 (67-77.25) years and the median preoperative prostate volume 74.5 (45-110) ml. 12 (22.2%) patients were treated with ongoing anticoagulant treatment. The median operative time was 65 (41-81) min and the enucleation efficiency 1.11 (0.82-1.79) g/min, respectively. Clavien 1 (11.1%), Clavien 2 (3.7%), Clavien 3a (3.7%), and Clavien 3b (5.5%) complications occurred. At 6-month follow-up, median prostate volume (74.5 vs. 15.5 ml) and PSA (4.03 vs. 0.54 µg/l) had improved significantly compared to baseline (p = 0.009). At 12-month follow-up, Qmax (12 vs. 29.3 ml/s), PVR (155 vs. 11.15 ml), IPSS (22 vs. 6) and QoL (5 vs. 1) had improved significantly (p < 0.001). Conclusions: LP-HoLEP is technically feasible, safe and effective for the treatment of symptomatic BPO. For experienced surgeons, power is less relevant than technique. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have shown that thulium vapoenucleation of the prostate (ThuVEP) is a size-independent minimally invasive procedure for the treatment of benign prostatic enlargement. All ThuVEP series have been performed with a 2-µm thulium laser device so far. The aim of this study was to evaluate the complications and early postoperative results of two thulium-devices with different wavelengths for ThuVEP in prostates larger than 80 ml.Materials and Methods: A retrospective bi-centric matched-paired analysis with 296 patients was performed. Based on prostate size, 148 were matched at each centre and laser device, respectively. A 2-µm (RevoLix, LISA Laser products, Katlenburg, Germany n=148) and a 1.9-µm (vela XL, starmedtec, Starnberg, Germany, n=148) thulium laser with a power output of 90 and 80 W was used. Patients' data were assessed and compared.Results: The median prostate volume (interquartile) was 100 ml (range 86.25-120 ml). At discharge, Qmax (preoperative 7.9 and 9 ml/s vs. postoperative 19.35 and 16.2 ml/s) and postvoiding-residual urine (preoperative 130 and 45 ml vs. postoperative 20 and 25 ml) were significantly improved after 2-µm and 1.9-µm ThuVEP (p<0.001). The median catheterization time and hospitalization times were 2 and 4 days in both groups. Perioperative complications occurred in 89 patients (30.1%): Clavien 1 (12.2%), Clavien 2 (9.1%), Clavien 3a (0.7%), Clavien 3b (7.1%), and Clavien 4a (1%). Regarding the occurrence of complications, there were no differences between the two thulium devices.Conclusion: ThuVEP represents a safe and effective treatment for prostates larger than 80 ml. Both thulium laser devices give satisfactory immediate micturition improvement with low perioperative morbidity. [ABSTRACT FROM AUTHOR]