Efficacy of transurethral thulium laser vapoenucleation of the prostate combined with 12-o'clock urethral mucosal preservation for small-volume benign prostatic hyperplasia: a retrospective study.

PURPOSE: To evaluate the clinical efficacy of transurethral thulium laser vapoenucleation of the prostate (ThuVEP) combined with the 12-o'clock urethral mucosal preservation technique for treatment of small-volume benign prostatic hyperplasia (BPH), focusing on incidences of bladder neck contracture and urinary incontinence, as well as improvements in quality of life (QoL). METHODS: This retrospective analysis included 102 patients with small-volume BPH who underwent the modified ThuVEP procedure between June 2018 and December 2024. The modified technique emphasized preservation of the urethral mucosa at the 12-o'clock position. RESULTS: The mean preoperative prostate volume was 35.4 mL, mean operative time was 35 min (range, 25-50 min), and median catheterization time was 4 days. After a median follow-up of 27 months, all patients achieved satisfactory postoperative voiding. The median maximum urinary flow rate (Qmax) was 24.2 mL/s and median post-void residual volume (PVR) was 20 mL. Both postoperative the International Prostate Symptom Score (IPSS) and QoL score significantly improved (p < 0.01). Eight patients developed mild, transient urinary incontinence, which spontaneously resolved within 1 month. No bladder neck contracture occurred during follow-up. CONCLUSION: ThuVEP combined with 12-o'clock urethral mucosal preservation provides robust relief of obstructive symptoms in patients with small-volume BPH; it has a high rate of immediate postoperative urinary continence and low incidence of bladder neck contracture. This modification represents a safe and effective surgical option for small-volume BPH, although long-term outcomes should be validated in larger cohorts with extended follow-up.