Since2010, Herrmann and colleagues introduced Thulium laser enucleation of the prostate (ThuLEP) as a versatile minimally invasive enucleation procedure; followed by several studies that have confirmed its feasibility and efficacy such as HoLEP. Our aim was to present the feasibility of adopting both top or down techniques during a self-taught, ThuLEP, learning curve for a single surgeon with no previous HoLEP experience.

Between February 2018 and March 2019, a well-trained endourologist; who didn’t perform laser enucleation of the prostate before, started reviewing the available literature, attended more than 15 procedures at another hospital and participated in 3 laser enucleation of prostate workshops. 29 patients with a prostate size between 80 and 120 grams underwent ThuLEP without tutoring or mentor supervision.  We used Revolix DUO TM machine with a 40-watt setting for both cutting and coagulation with a 550-mic fiber for all cases.

In the 1st 4 cases, the surgeon was unable to completely enucleate the 1st lobe and ended with open prostatectomy. In the following 4 cases, one lobe was completely enucleated and morcellated while the other lobe was finished by bipolar resection. The following 10 cases the down technique was the primary strategy for a successful enucleation. Then the last 11 cases were successfully completed by a combination of down and top technique. All patients had a satisfactory voiding outcome with a mean Qmax of 24.5 after surgery.

ThuLEP extraordinary hemostatic effect and the limited penetration depth may allow it to be the standard step for beginner surgeon, while adopting both top and down technique may be the easiest way for accelerating the learning curve for surgeons performing ThuLEP.