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

Authors

Vineet Gauhar, Daniele Castellani, Bhaskar Somani, Ioannis Kartalas Goumas, Karl Tan, Biligere Sarvajit, Khi Yung Fong, Steffi Kar-Kei Yuen, Marek Zawadzki, Giorgio Bozzini, Thomas Herrmann, Ee Jean Lim

Published in

World journal of urology. Volume 44. Issue 1. Aug 13, 2026. Epub Aug 13, 2026.

Abstract

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.
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.
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.
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.

PMID:
42593553
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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