Does pulse modulation technology improve endoscopic enucleation of the prostate? Real-world comparison of three contemporary laser platforms in 447 patients

Background Anatomical Endoscopic enucleation of the prostate (AEEP) has emerged as a highly effective surgical treatment for benign prostatic enlargement, with multiple laser platforms now available. This study compares perioperative and early postoperative outcomes across three distinct laser systems. Methods We analysed 447 patients who underwent AEEP across seven centres between March and August 2025. Patients were divided into three groups: Group 1 (n = 184) treated with Holmium: YAG laser employing Magneto technology, Group 2 (n = 64) with high-power Holmium: YAG laser, and Group 3 (n = 199) with pulsed Thulium: YAG laser. Perioperative parameters, complications, and three-month functional outcomes were assessed. Results Group 3 demonstrated superior operative efficiency with shortest median total operation time (45 vs. 60 vs. 65 min, p < 0.001) and enucleation time (22 vs. 33 vs. 33 min, p < 0.001). No patients in Group 3 required electrocautery for haemostasis compared to 20.7% in Group 1 and 35.9% in Group 2 (p < 0.001). No patient required blood transfusion. No major complications occurred. Readmission for bleeding requiring manual clot evacuation occurred in 6.2% of Group 2 patients and 0.5% of Group 3 patients, with no cases in Group 1 (p < 0.001). Early and late urinary incontinence was significantly lower in Group 3 versus Groups 1 and 2. All platforms achieved substantial functional improvements at 3-month follow-up. No major complications. Conclusions While all three laser platforms achieved effective surgical outcomes with favourable safety profiles, the pulsed Thulium: YAG and Holmium: YAG lasers with magneto technology were associated with advantages in hemostasis and continence outcomes.