Holmium: YAG laser enucleation of the prostate using the new cyber Ho generator with magneto technology: does it provide any advantages compared to thulium: YAG prostate enucleation?

Purpose: To assess differences in efficacy and safety between Thulium:YAG laser enucleation of the prostate (ThuLEP) and enucleation performed with the Holmium:YAG Cyber Ho laser generator (HoLEP) with Magneto technology (Quanta System®).

Methods: Patients with surgical indication for benign prostatic hyperplasia underwent ThuLEP using Cyber TM generator (Group A) versus HoLEP using Cyber Ho generator with Magneto technology (Group B). In Group A settings were 100W for enucleation and 35W for coagulation. In Group B early apical detachment and coagulation were performed with energy 1 J and frequency 30 Hz by applying Magneto technology. Enucleation was performed with energy 2 J and frequency 40 Hz by applying Virtual Basket pulse modulation.

Results: 200 patients were enrolled (100 patients per group). Preoperative features were comparable. Mean prostate size was 78.9 vs. 80.5 ml in Group A vs. B (p = 0.09). Mean operative time was 70.6 vs. 64.3 min (p = 0.13) with mean enucleation time 48.8 vs. 43.7 min (p = 0.21) and morcellation time 21.2 vs. 14.6 min (p = 0.03) in ThuLEP vs. HoLEP group. Micturition improvements were comparable. Postoperative gross haematuria was significantly more frequent after ThuLEP and clots-induced urinary retention occurred in 5.0% of cases, compared to no cases after HoLEP (p = 0.02).

Conclusions: HoLEP using the Cyber Ho generator with the application of Magneto technology for coagulation seems to provide an haemostatic advantage compared to ThuLEP, suggested by the significantly shorter morcellation time, higher morcellation efficiency and lower rate of postoperative gross haematuria and clots-induced urinary retention. Functional outcomes are comparable.