Holmium laser ablation of large prostate glands: An endourologic alternative to open prostatectomy

Purpose: To assess the efficacy and safety of holmium laser ablation of the prostate (HoLAP) to treat patients with large glands who would otherwise be recommended for open prostatectomy. Patients and Methods: A series of 17 patients aged 54 to 79 years (mean 68.2 years) with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) (n = 14) or prostate carcinoma (n = 3) and a transurethral ultrasonography-assessed prostate volume of 80 cc were treated with a 100 W holmium laser. The endpoint of treatment was complete vaporization of obstructing prostate tissue down to the capsular fibers with an adequate prostate cavity. Results: The mean laser time was 77 minutes (range 43-203 minutes), the catheter time 2.12 days (range 1-5 days), and the length of stay 1.34 days (range 1-3 days). None of the patients required continuous bladder irrigation. Prostate volume decreased from 121.82 +/- 42.10 cc to 54.58 +/- 20.65 cc (55%; P < 0.01). The American Urological Association Symptom Score decreased from 20.41 +/- 5.35 to 5.70 +/- 2.20 (70%; P < 0.01). The peak urinary flow rate (Qmax) increased from 6.92 +/- 5.71 to 15.06 +/- 7.57 (217%; P < 0.01). Serum sodium changed from 138.53 +/- 2.50 mEq/L to 138.00 +/- 3.29 mEq/L (P = 0.4). Hemoglobin changed from 14.4 +/- 1.15 g/dL to 13.58 +/- 1.29 g/dL (-5%). No patient had postoperative stress incontinence. Conclusion: The HoLAP technique is effective in the treatment of patients with LUTS secondary to BPH and for some patients with prostate carcinoma. Because of the excellent hemostatic properties of the holmium laser wavelength, large glands can be vaporized safely with minimal morbidity and a short hospital stay. The clinical advantages over open prostatectomy include clinically insignificant perioperative blood loss, no stress incontinence, short duration of catheterization, and no skin incision.