Back to 2026 Abstracts
The Paradox of Severe Baseline LUTS: Predictors of Early Satisfaction After ThuFLEP
Jack Edward Mulcrone, BA, Daniel Sanford, MD, Jarrett Noakes, BS, Raymond Chiang, BS ScM, Andrew Tompkins, MD, Samuel Eaton, MD.
The Warren Alpert Medical School of Brown University, Providence, RI, USA.
BACKGROUND: Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) is an established treatment for BPH, yet predictors of postoperative outcomes and patient satisfaction remain unclear. Patients with more severe baseline symptoms and/or pre-operative urinary retention may be assumed to have greater postoperative satisfaction due to larger absolute improvements; however, this assumption has not been well examined. Here, we aim to identify predictors of early satisfaction which may help refine pre-operative counseling and expectation setting.
METHODS: We retrospectively reviewed 250 patients undergoing ThuFLEP at a tertiary center. Preoperative data included demographics, comorbidities, prostate size, prostate-specific antigen (PSA), post-void residual (PVR), and International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores. The primary outcome was early postoperative satisfaction (IPSS ≤8 and QoL ≤2) at 4 weeks. Multivariable logistic regression identified independent predictors.
RESULTS: Severe baseline lower urinary tract symptoms (IPSS >21) were independently associated with significantly lower odds of early postoperative satisfaction (OR 0.19, 95% CI 0.04-0.84, p=0.028). Increasing prostate size demonstrated a trend toward reduced likelihood of satisfaction (OR 0.98 per gram, p=0.074), though this did not reach statistical significance. No significant associations were observed for age, PSA, smoking status, preoperative PVR, comorbidity burden, or preoperative urinary retention. Symptom improvement was substantial overall, with nearly half of patients achieving mild symptoms (IPSS ≤8) by 4 weeks and nearly two-thirds by 6 months.
CONCLUSIONS: ThuFLEP provides meaningful and sustained urinary symptom relief for most patients; however, severe baseline LUTS predicted lower odds of early postoperative satisfaction. This finding highlights the importance of setting pre-operative expectations for patients with severe baseline LUTS. Reassuringly, with time, the majority of patients had significant improvement and satisfaction following surgery.
Back to 2026 Abstracts
