Holmium laser resection of the prostate: Preliminary results of a new method for the treatment of benign prostatic hyperplasia

Objectives. To assess the early efficacy and safety of holmium laser resection of the prostate (HoLRP) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). Methods. The initial 84 patients undergoing HoLRP at this institution are reported. All patients underwent standard urologic evaluation for BPH with American Urological Association (AUA) symptom score, peak urinary flow rate (Q(max)), ultrasound prostate volume estimation, prostate-specific antigen and digital rectal examination. The patients were reassessed at 1 month (72 patients) and 3 months (48 patients) postoperatively. The resection time, total operating time, holmium energy used (kilojoules), catheter time, and hospital stay were all recorded. Results. The mean patient age was 65.3 years (49 to 80). The mean AUA score improved from 21.3 preoperatively to 7.6 at 1 month and 4.1 at 3 months. The mean Q(max) likewise increased from 7.5 mL/s preoperatively to 17.8 mL/s at 1 month and 19.3 mL/s at 3 months. Two patients (2%) required bladder irrigation for heavy hematuria perioperatively and 4 patients (5%) required recatheterization. Few patients experienced irritative urinary symptoms and to only a mild degree. Conclusions. The technique of HoLRP produces a cavity identical in appearance to transurethral resection of the prostate. It is a relatively bloodless procedure that results in a short catheter time, immediate symptomatic improvement, and minimal postoperative irritative symptoms. The short-term results are excellent but longer-term follow-up is necessary.