ThuLEP: thulium laser enucleation of the prostate

How ThuLEP works

The prostate has an outer shell and an inner part that enlarges with BPH. In ThuLEP the surgeon uses a thulium laser, passed through a scope in the urethra, to separate the enlarged inner tissue from the shell, much like peeling an orange. The freed tissue is pushed into the bladder, broken into small pieces with a device called a morcellator and removed. The laser also seals small blood vessels as it works.

Who may be a candidate

• Men with moderate to severe BPH symptoms that medication has not controlled.
• Men with large prostates.
• Men with BPH complications, such as urinary retention, bladder stones or repeated infections.

Other options include UroLift, prostate artery embolization, Aquablation and TURP and HoLEP.

Before surgery

Your evaluation can include a urine test, a urine flow test, an ultrasound to measure the prostate and leftover urine, and a cystoscopy. You will be told which medications to stop beforehand, especially blood thinners, and when to stop eating and drinking.

Recovery and possible side effects

• A catheter drains the bladder for a short time after surgery.
• Burning, urgency and some blood in the urine are common for a few weeks.
• Some men have temporary leaking of urine while the bladder adjusts.
• Dry orgasm (retrograde ejaculation) is common after enucleation.
• Less common risks include bleeding that needs treatment, infection and narrowing of the urethra.

ThuLEP FAQ

What does ThuLEP stand for?

Thulium laser enucleation of the prostate. "Enucleation" means the enlarged inner part of the prostate is separated from its outer shell and removed.

How is ThuLEP different from HoLEP?

Both remove the enlarged inner part of the prostate through the urethra with a laser. ThuLEP uses a thulium laser and HoLEP uses a holmium laser. Your urologist will recommend the approach that suits you; see TURP and HoLEP.

Is ThuLEP an option for a large prostate?

Enucleation procedures can be used for large prostates. Your urologist will measure your prostate and discuss your options.

Will I need a catheter?

Yes, for a short time after surgery while the area heals.

Does ThuLEP affect ejaculation?

Many men have dry orgasm (retrograde ejaculation) after enucleation, meaning semen goes into the bladder instead of out. Discuss this with your urologist if it matters to you, including for fertility.