Minimally invasive laser modalities have become increasingly popular, and thulium laser vaporization of the prostate (ThuVAP) is no exception. Some studies reported improvements in IPSS, Qmax, and PVR after a subset of their patients underwent ThuVAP. We present our 12-month ThuVAP outcomes and evaluate the safety and efficacy outcomes of resident-performed ThuVAP by comparing these surgeries to attending-performed ThuVAP cases.

Medical records were retrospectively reviewed from September 2022 to August 2024, which included 77 consecutive men who underwent ThuVAP by two residents and three attending urologists. Data were collected from residents performing ThuVAP and attending surgeons performing ThuVAP for comparison. Recorded data included patient demographics, pre-and postoperative IPSS, QOL, OABSS score, Qmax, PVR, duration of surgery, and postoperative complications. Patients were evaluated at 1 month, 3 months, 6 months, and 12 months postoperatively. ThuVAP was performed using the CyberTMⓇ laser (Quanta System) under general anesthesia. Vaporization was performed at 200W.

Cases were reviewed for 77 patients, comprising 44 resident ThuVAP cases and 33 attending ThuVAP cases. The mean age was 74 ± 8.3 years, with an average prostate size of 69.9 ± 35.3 mL. At baseline, the mean IPSS was 19.1 ± 8.3, and the QOL Score was 4.5 ± 1.4. The mean baseline Qmax was 6.2 ± 3.3 mL/sec, and PVR was 158 ± 109.7 mL. Twenty-eight patients (36.4%) had urethral catheters at the time of surgery due to urinary retention. Significant improvements from baseline were observed in Qmax, PVR, IPSS, and QOL scores at all follow-up intervals. The mean hospital stay was 5.8 ± 2.0 days. There were no statistically significant differences in patient demographics or preoperative data between the attending ThuVAP and resident ThuVAP groups. However, there was a statistically significant difference in procedure duration between the two groups, with resident cases taking an average of 96.7 ± 32.1 minutes and attending cases taking 78.4 ± 23.9 minutes (p < 0.001). At 12 months, the mean Qmax showed significant improvement in the attending group (p = 0.045). Nevertheless, postoperative IPSS and QOL scores did not differ between resident and attending surgeons.

We observed significant improvements in Qmax, PVR, IPSS, and QoL at all time points when compared with baseline during the 12 months of follow-up. ThuVAP appears to be a safe and effective technique with durable outcomes at 12 months. In our study, the ThuVAP performed by resident surgeons had comparable outcomes to the ThuVAP performed by attending surgeons. However, there was a significant difference between the two groups in postoperative Qmax at 12 months. This difference is most likely attributed to the higher rate of residual adenoma in resident ThuVAP cases. Our data also demonstrated that resident ThuVAP cases required a longer operating time to complete compared to attending ThuVAP cases. The resident ThuVAP cases were completed by PGY-3 residents who have no solid foundation in TUR surgery, so our outcomes are limited to this cohort of residents. Our study was limited by its retrospective design and relatively small sample size. This study suggested that under direct attending urologist supervision, excellent outcomes can be maintained while residents receive training in ThuVAP.