Recent developments in Thulium:YAG laser technology introduced generators capable of delivering pulsed energy for endoscopic enucleation of the prostate (EEP). This systematic review summarized applications and reported outcomes of pulsed Thulium:YAG generators when used for anatomic EEP.
The review followed PRISMA guidance and had a protocol registered a priori on the OSF database. Three electronic databases—PubMed, Scopus and the Cochrane Library—were searched from inception through 4 May 2026 using the search string: (pulsed OR hybrid) AND (thulium:YAG OR tm:YAG). A manual search supplemented database screening. Inclusion criteria and the search strategy were framed using the PICO model (Patients, Intervention, Comparison, Outcome).
Eight studies met the predefined inclusion criteria and were included in the systematic review. Device distribution among included studies was as follows: six studies used the exclusively pulsed Dornier Thulio generator and two studies used the hybrid LISA RevoLix HTL generator. Study designs comprised three non-comparative cohorts and five comparative studies. Among comparative reports, four studies evaluated pulsed Thulium:YAG against Holmium:YAG, while one study compared miniaturized pulsed Thulium:YAG EEP to a standard pulsed Thulium:YAG approach.
Across the included reports, operative and stage-specific times varied. Mean total operative time ranged from 40.8 ± 21.7 minutes to 101.7 ± 18.5 minutes. Reported mean enucleation times spanned from 18.3 ± 8.9 minutes to 83.7 ± 17.2 minutes. Morcellation times were reported between 10.2 ± 10.1 minutes and 18 ± 5.1 minutes. These ranges reflect heterogeneity in cohorts, techniques, device models and reporting but indicate that EEP with pulsed Thulium:YAG was performed within conventional timeframes reported for endoscopic prostate enucleation.
Complication rates using Clavien–Dindo classification varied across the included studies. Grade I–II complication rates were reported between 1% and 8.1%. Grade III–IV complication rates ranged from 0% to 15.6%. Postoperative urinary incontinence rates reported in the studies varied from 0% up to 18.4%. The abstract does not provide study-level breakdowns of specific complications, their management, or the temporal pattern of incontinence; those details were not reported in the source abstract.
The included studies reported postoperative improvements in standard functional and symptom metrics after EEP with pulsed Thulium:YAG. Specifically, improvements were noted in the International Prostate Symptom Score (IPSS), patient Quality of Life (QoL) scores, post-void residual urine volume (PVR) and maximal urinary flow rate (Qmax). The abstract does not provide numerical pooled effect sizes, mean differences or time points for these improvements; such granular data were not reported in the source abstract.
Among the five comparative studies, four compared pulsed Thulium:YAG to Holmium:YAG technology. According to the summary in the abstract, Holmium:YAG and pulsed Thulium:YAG lasers were associated with comparable results in the limited number of studies available. One study compared miniaturized versus standard pulsed Thulium:YAG EEP; the abstract notes this comparison existed but does not detail relative advantages or quantitative differences. The abstract does not report pooled comparative statistics, measures of heterogeneity, or subgroup analyses.
The authors concluded that anatomic EEP using pulsed Thulium:YAG generators appears feasible, safe and efficient, with relatively low overall complication and incontinence rates across the included studies. Both the purely pulsed and hybrid generators were associated with favorable postoperative outcomes in symptom scores and objective measures (IPSS, QoL, PVR, Qmax). In direct comparisons, pulsed Thulium:YAG and Holmium:YAG produced comparable results in the small set of available comparative studies.
Limitations: the abstract does not report detailed study-level data, durability or long-term outcomes, quantitative pooled estimates, or specifics on patient selection and follow-up duration. Where the source abstract lacked detail, those data are not available here and were not inferred.
For clinicians considering energy sources for EEP, the available systematic-review-level evidence summarized in the abstract suggests pulsed Thulium:YAG is a viable option with operative times, complication profiles and functional improvements consistent with established endoscopic enucleation approaches. Direct comparative evidence with Holmium:YAG is limited but did not demonstrate clear superiority of either technology in the studies included in this review.
This summary is based solely on the PubMed abstract and bibliographic information provided for the cited systematic review (PMID: 42633610; DOI: 10.1007/s00345-026-06706-5). Additional methodological and numerical details from the full text, including study-by-study results, follow-up durations and statistical analyses, were not reported in the abstract and therefore are not included here.