Bladder neck contracture (BNC) is a relevant long-term complication after transurethral resection of prostate. Proposed mechanisms causing BNC are extensive resection as well as excessive fulguration in the bladder neck leading to scar tissue formation. In this study, we evaluated the outcomes of Thulium laser enucleation of the prostate (ThuLEP) with a delayed cut of the bladder neck mucosa in men with smaller prostate volumes.

Consecutive men who underwent ThuLEP by a single surgeon from 2017 to 2022 were identified. We performed all-in-one-lobe anatomical enucleation technique for ThuLEP. At the bladder neck, we bluntly enucleated the prostatic adenoma from the mucosal attachment between the adenoma and the bladder neck. To maintain mucosal integrity and refrain from entering the bladder until the adenoma is clear from approximately one half of the circumference of the bladder neck. This procedure ensured a complete removal of the prostatic adenoma with bladder neck preservation.

Overall, 492 patients were included, and 68 patients with a prostate volume less than 40 cm3 were analyzed. The average age of these patients was 70.7 ± 7.13 years, the pre-operative average prostate size was 32.8 ± 5.0 cm3, the average enucleation time was 47.8 ± 11.1 minutes, and the average weight of specimen was 9.1 ± 4.8 g. No case of BNC was detected during the average follow-up period of 20.1 ± 9.3 months.

Using ThuLEP with a delayed cut of the bladder neck mucosa, we minimized the incidence of BNC inpatients with prostate volume less than 40 cm3.