Thulium laser vaporization of the prostate (ThuVAP) has emerged as a safe and minimally invasive alternative to transurethral resection of the prostate (TURP) for treating benign prostatic hyperplasia (BPH). It is particularly suitable for patients with large prostates, middle lobe enlargement, or those receiving antithrombotic agents, owing to its superior hemostatic properties. Although its efficacy and safety have been reported, there remains limited evidence regarding real-world outcomes when all medications for BPH and overactive bladder (OAB) are discontinued postoperatively. This study aimed to assess six-month functional outcomes, focusing on both symptom relief and objective voiding parameters following ThuVAP in a real-world cohort without ongoing pharmacologic therapy.

This retrospective study included 17 male patients who underwent ThuVAP between June 2023 and August 2024 by a single experienced urologist. All patients discontinued BPH and OAB medications postoperatively. Parameters evaluated preoperatively and at 6 months included uroflowmetry results—maximum flow rate (Qmax), postvoid residual (PVR), bladder voiding efficiency (BVE)—as well as symptom questionnaires: IPSS (total, storage, voiding subscores, and QOL), and OABSS. OAB was defined as an urgency score ≥2 and total OABSS ≥3. Patients no longer meeting both criteria postoperatively were considered OAB-resolved. Statistical analysis used paired t-tests, and associations with OAB resolution were assessed via Spearman’s correlation.

The mean age was 68.0 years and mean prostate volume was 85.0 mL. Additional baseline patient characteristics, including medication history and urinary retention status, are summarized in Table 1. Among 14 patients without preoperative urinary retention, Qmax improved significantly from 7.4 to 15.0 mL/s (p < 0.0001), PVR decreased from 139.1 to 52.4 mL (p = 0.0008), and BVE increased from 44.8% to 84.3% (p < 0.0001). Total IPSS decreased from 26.2 to 8.1 (p < 0.0001), with storage (p = 0.0003) and voiding (p < 0.0001) subscores also significantly improved. The QOL score improved from 6.2 to 2.1 (p < 0.0001). Among 10 patients with OAB at baseline, 6 (60%) no longer met OAB diagnostic criteria. Younger age was significantly associated with OAB resolution (Spearman’s ρ = –0.855, p = 0.0016). Two of 3 patients with preoperative urinary retention successfully discontinued catheter use. No postoperative urinary retention or reoperation was observed. Figure 1 illustrates the mean changes in all symptom scores and voiding function parameters.

ThuVAP provided significant and comprehensive improvements in both voiding and storage symptoms at 6 months postoperatively, even after complete withdrawal of medical therapy. The procedure demonstrated favorable outcomes in a real-world setting, including among patients with large prostates or prior urinary retention. ThuVAP may serve as an effective and well-tolerated alternative to conventional surgical options for BPH management.