HOLMIUM LASER RESECTION OF THE PROSTATE VERSUS NEODYMIUM - YTTRIUM-ALUMINUM-GARNET VISUAL LASER-ABLATION OF THE PROSTATE - A RANDOMIZED PROSPECTIVE COMPARISON OF 2 TECHNIQUES FOR LASER PROSTATECTOMY

Objectives. To directly compare holmium laser resection of the prostat e (HoLRP) with neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate (VLAP), which represent two fundamentally different m ethods of laser prostatectomy. Methods. In a randomized, prospective c omparison, a total of 44 men with symptomatic benign prostatic hyperpl asia (BPH) were treated with either HoLRP or VLAP. Standard preoperati ve assessment included American Urological Association (AUA) symptom s core, peak urinary flow rates (Qmax), ultrasound prostate volume, and residual urine measurements. Pressure-flow urodynamics were performed preoperatively and at 3 months postoperatively. Intraoperative and per ioperative factors were assessed. The patients were followed at 1, 3, 6, and 12 months following the procedure. Results. There were no signi ficant differences between the patient groups for any preoperative par ameter. The mean total operating time was longer in the HoLRP group (5 2 minutes) compared with the VLAP group (41 minutes) (P <0.01). The me an catheter times were 1.4 days (HoLRP) and 11.6 days (VLAP) (P <0.001 ). These times included the 9% of patients undergoing HoLRP and 36% of patients undergoing VLAP who required recatheterization. Immediate po stoperative dysuria scores were higher in the VLAP group compared with the HoLRP group. There were no significant differences in AUA scores between the two treatment groups at any postoperative interval. The Qm ax values were greater at follow-up in the HoLRP group, but statistica l significance was not achieved at 12 months. However, both PdetQmax a nd Schafer grade measurements taken at 3 months postoperatively were s ignificantly lower in the patients undergoing HoLRP. Three patients (1 4%) required reoperation in the VLAP treatment arm but no patient who underwent HoLRP has required reoperation to date. Conclusions. HoLRP r esults in significantly improved patient outcomes compared to VLAP. (C ) 1998, Elsevier Science Inc. All rights reserved.