Urodynamic de-obstruction and symptom improvement after thulium laser vaporization (ThuVAP): evidence from a prospective paired study

Background: Thulium laser vaporization of the prostate (ThuVAP) is an established treatment for benign prostatic obstruction, but its impact on urodynamic parameters remains poorly defined. This study aimed to quantify the de-obstructive efficacy of ThuVAP through pre- and postoperative urodynamic comparisons and to assess the relationship between urodynamic improvement and symptom relief. Methods: In a prospective single-center cohort (June 2022–June 2024), men with urodynamically confirmed obstruction underwent standardized ThuVAP with a 200-W thulium:YAG system. Baseline and 6-month invasive urodynamics and 12-month clinical follow-up were performed. The primary endpoint was the change in the bladder outlet obstruction index (BOOI); secondary endpoints included Qmax, postvoid residual volume (PVR), bladder voiding efficiency (BVE), detrusor pressures, and International Prostate Symptom Score (IPSS). Results: Sixty-four patients (mean age 67 years; prostate volume 52 mL) were analyzed. BOOI decreased from 55.9 ± 17.2 to 21.3 ± 11.2 (p < 0.001), with obstructed cases dropping from 79.7% to 7.8%. Schäfer grade fell from 3.6 to 0.3 (p < 0.001). Detrusor pressure halved, Qmax rose from 7.9 to 20.8 mL/s, PVR declined from 121 to 22 mL, and BVE improved from 64% to 94% (all p < 0.001). Low compliance and involuntary detrusor contractions (IDC) decreased notably. IPSS improved from 26.2 to 3.4 (p < 0.001) and correlated with the magnitude of urodynamic de-obstruction. Conclusions: ThuVAP provides substantial, objectively verified relief of bladder outlet obstruction with consistent improvements in voiding efficiency and symptoms. The correlation between urodynamic and clinical outcomes underscores the procedure’s efficacy and the utility of urodynamics in documenting therapeutic benefit.