Assessing the trifecta of enucleation using Magneto laser energy on different prostate volumes in real world practice, an EAU-endourology and AUSET collaboration.

BACKGROUND: This study aimed to evaluate the real-world trifecta efficacy of the Magneto laser technology used in endoscopic enucleation of the prostate (EEP), defined by three criteria: absence of Clavien-Dindo grade II, III, or IV complications within the first 30 days postoperatively; maximum urinary flow rate (Qmax) > 15 ml/sec within 3 months; and the absence of stress urinary incontinence beyond the 3-month follow-up period. METHODS: This study included any patient fit for EEP for benign prostatic hyperplasia with the Magneto laser technology in five countries from March-September 2025. Exclusion criteria were concomitant surgery and patients < 18 years of age. Patients were divided into two cohorts for comparison according to prostate volume (< 80 cc and ≥ 80 cc). Baseline demographics, operative characteristics and postoperative outcomes were compared and reported as per trifecta definition. RESULTS: 184 patients were analyzed; 85 had prostate volume < 80 cc and 99 had prostate volume ≥ 80 cc. Median age was 70 years, median preoperative IPSS was 27, median preoperative maximum flow rate was 7.3 ml/s, 50% had a preoperative indwelling catheter for retention, and 19.6% were on antiplatelet or anticoagulant use at baseline. Most underwent en-bloc enucleation (98.4%) with early apical release (100%). Operative times and rollerball usage were similar in both groups, and more patients with larger prostates received postoperative tranexamic acid (51.5% vs. 27.1, p = 0.001). Median hospital stay was 1 day, and only 2.2% of patients required continuous bladder washout to be restarted due to bleeding. 83.5% underwent successful trial off-catheter. From a trifecta perspective, median improvements in IPSS and Qmax were 20 and 10 ml/s respectively at 3 months. There were no major Clavien Dindo II-IV complications noted. No readmissions within 30 days or urethral strictures within 3 months were seen. Postoperative urinary incontinence of any aetiology was observed in 25.5% of patients within the first 3 months; however, only 1.1% experienced persistent urge urinary incontinence beyond 3 months, with 1 case of stress urinary incontinence recorded beyond this threshold. CONCLUSIONS: EEP with the Magneto laser is a safe and effective procedure with significant subjective and objective symptomatic improvement. Most cases of post-EEP incontinence were temporary, and outcomes were favorable even with large prostates.