The results of holmium laser resection of the prostate.

OBJECTIVE: To assess the results of holmium-laser resection of the prostate (HOLRP) in the treatment of benign prostatic hyperplasia. PATIENTS AND METHODS: Between 1994 and 1997, 967 patients underwent HOLRP in Tauranga, New Zealand, and in Derby, United Kingdom. The patients were followed at 1, 3 and 6 months after treatment using measurements of symptom score and urinary flow rate. RESULTS: There was a large and sustained improvement in symptom scores and urinary flow rates, with no mortality and low morbidity. CONCLUSION: We recommend this technique as an alternative to transurethral resection in the surgical treatment of bladder outlet obstruction due to benign prostatic hypertrophy.

Holmium: YAG laser resection of prostate (HoLRP) for patients in urinary retention.

We examined the holmium:YAG (Ho:YAG) laser as a tool to perform acute resection of obstructing prostatic tissue in the subgroup of men with benign prostatic hyperplasia (BPH) who present in urinary retention. A total of 36 men presented in acute urinary retention requiring catheterization before undergoing Ho:YAG laser resection of the prostate (HoLRP). Their mean age was 67 years. The mean laser energy delivery was 102 kJ (range 42-315 kJ). The mean postoperative catheterization time was 1.5 days (range 1-8 days), and only 3 men required a catheter for more than 48 hours. There were no acute perioperative complications. Improvement in voiding was immediate and sustained through 6 months of follow-up. At 6 months, the mean peak urinary flow rate was 22.5 mL/sec, and the AUA Symptom Index Score was 5.7. A meatal stricture requiring dilation in one man represents the sole late complication observed in this series. Late recurrence of urinary retention has occurred in two men who had contributing medical problems, for an overall treatment failure rate of 5.6%. Thus, HoLRP represents an effective surgical therapy for patients with bladder outlet obstruction presenting in urinary retention. Morbidity is minimal compared with electrocautery resection, while the efficacy and immediacy of voiding improvement appear similar.