ThuFLEP (Thulium Fiber Lazer Enucleation of Prostate)

ThuFLEP (Thulium Fiber Lazer Enucleation of Prostate)

The term ThuFLEP stands for “Thulium Fiber Lazer Enucleation of Prostate”. The laser technologies used in the treatment of benign prostate growth (BPH) are holmium laser (HoLEP), thulium laser (ThuLEP) and thulium fiber laser (ThuFLEP), the most up-to-date laser technology.

What is ThuFLEP Surgery?

It is a surgical technique in which the entire prostate tissue can be removed and taken out. It is the process of separating the prostate adenoma from the prostate capsule using laser energy. Today, laser enucleation techniques have replaced open surgery, especially in large prostates, and have been accepted as the gold standard treatment.

How is ThuFLEP Surgery Performed?

HoLEP, ThuLEP and ThuFLEP surgeries have the same technique. In other words, the surgical technique and method are the same except for the laser types used in these surgeries called laser prostatectomy.

After the patients are evaluated by the anesthesiologist according to their current diseases and conditions, surgery is performed with full anesthesia (general anesthesia) or spinal anesthesia. The operation is started by entering the external urinary tract in the penis with camera tools. The external urinary tract, prostate tissue, the structure we call the sphincter that allows us to retain urine, and the bladder are visualized with a camera. Then, with the thulium fiber laser, the prostate adenoma is separated from the structure we call the capsule by laser drawing, without going beyond the sphincter. If we think of this prostate like an orange, the fruit of the orange, which we call the adenoma, is removed, and the shell part, which we call the capsule, remains. Roughly the fruit of the orange is peeled off in a way that leaves the peel.  Meanwhile, especially the thulium fiber laser continuously emits energy absorbed in low-energy water, thus reducing bleeding.  Prostate adenomas are sent to the bladder either as whole pieces or as a few pieces after leaving the capsule. These parts are taken out of the bladder with the effect of vacuum by turning them into small pieces with a tool called a morselator. The parts taken are sent to the laboratory for pathological examination. Then, the surgery is terminated after the catheter is inserted into the bladder.

Who are the Patients Suitable for ThuFLEP Surgery?

It is a method that can be applied to prostates of all sizes from all age groups. Especially large prostates have replaced the old method of open surgery, which has been accepted as the gold standard for many years. It has reliable and successful results as well as open surgery. It allows patients who cannot urinate due to the large prostate and who have catheter insertion to get rid of the catheter. In case of simultaneous bladder stone, the stone is broken in a short time by increasing to high energy levels with thulium fiber laser. In addition, if it is accompanied by stenosis in the urinary tract, it allows it to be opened with laser in stenosis. Since bleeding is less common, it can be applied safely, especially in patients using blood thinners.

What is the Hospitalization and Process After ThuFLEP Surgery?

On the day of surgery, the patients are overnight guests in the hospital. During hospitalization, washing fluid is removed from the catheter to prevent clot formation in the bladder. The patient can eat 4 hours after the surgery. Walking is done in the room and in the corridor on the evening of surgery. The patient is followed up until noon the next day. If the urine color from the catheter is clear, patients are discharged.

How Many Days Does the Catheter Stay After ThuFLEP Surgery?

The postoperative catheter stays for an average of 3 days depending on the size of the prostate and factors such as accompanying stenosis. In this process, it is recommended that patients drink plenty of water. The catheter bag is attached to the leg side with special tires, it does not prevent the patient’s movement and social life.

What is the Effect of ThuFLEP Surgery on Sexual Functions?

Thulium fiber laser acts at a depth of 0.15 mm. Since it affects a very small distance, its effect on the surrounding intact tissues is very low. It has no effect on structures such as veins and nerves. Thus, it has no effect on erection from sexual functions. Only retrograde ejaculation (retrograde ejaculation) of semen seen in all other prostate surgeries can be seen. This does not have any health problems. Since the prostate adenoma tissue is removed, the semen escapes to the closest place. The semen coming into the bladder is then excreted in the urine.

What is it like to return to normal social life after surgery?

It is recommended that patients drink plenty of water after the catheter is removed. In addition, foods and drinks that will cause irritation in the urinary tract are regulated under the control of a dietitian. One week after the surgery, normal life can be restored. Prolonged sitting travel and exposure to cold for the first month are not recommended. Heavy physical activities and sports should not be done. Antibiotic and anti-inflammatory treatments are continued for one week following the discharge prescription.

What is the Pathological Examination After ThuFLEP Sur-gery? When Are Results Announced?

Since vaporization was performed in GreenLight prostate surgery performed with KTP laser, we could not obtain prostate tissue for pathological examination.  After all current laser surgeries, prostate tissues morseled in HoLEP, ThuLEP, ThuFLEP operations are sent for pathological examination. The pathology result results in an average of 5-7 days.

Is Prostate Surgery Required Again After ThuFLEP Surgery, What are the Results?

Since laser enucleation techniques provide an anatomically real enucleation compared to the classical TUR-P method, the risk of re-adenoma tissue formation is very low. After the surgery, the patients’ complaints about urination disappear and their quality of life increases.

Should Prostate Controls Continue After ThuFLEP Surgery?

Since the prostate capsule remains after all benign prostate enlargement (BPH) surgeries, patients should regularly continue urology doctor controls with total PSA tests due to prostate cancer that may develop from these areas.