Transurethral holmium laser resection of the prostate - progress in the treatment of BPH?

After the initial enthusiasm subsided laser-coagulation of the prostate has been criticized because the extent of tissue destruction cannot be control led and many patients may be expected to have significant postoperative obs tructive as well as irritative voiding symptoms which may last for weeks. T hanks to new laservaporization techniques these disadvantages have been lar gely eliminated. With the Holmium laser a real resection of prostatic tissu e is possible allowing the surgeon to see the prostatectomy defect immediat ely and to assess tissue destruction during the operation ("what you see is what you get"). The postoperative voiding disturbances are diminished and comparable to those after TUR-P. At the Departement of Urology of the University of Berne 116 patients were treated with the Holmium laser for benign prostatic hyperplasia (BPH). Duri ng the initial learning period 12 patients required a secondary TURF due to persistent obstruction and in 12 patients a combined laser/conventional re section was performed due to underestimated prostate size. 5 patients were lost to follow-up. In the remaining 87 patients the median duration of cath eterization was 2 days. 10/87 patients required postoperative treatment for urinary tract infection. There were no significant perioperative decreases in hemoglobin and no cases of TUR syndrome. 66 patients have been followed for 6 months and 30 patients have been follo wed for 12 months. The maximum urinary flow improved from 7 ml/s preoperati vely to 15 ml/s at 6 months and 14 ml/s at 12 months. The volume of residua l urine decreased from a median of 120 ml preoperatively to 24 ml at 6 and 12 months. The IPSS decreased from a median of 20 pre-operatively to 3 at 6 and 12 months. In 50 patients followed with pressure-flow study pre- and 6 months postoperatively detrusor pressure at maximum flow decreased from 90 cm H2O to 55 cm H2O and linear PURR sank from 2,06 to 0,6. Taking into account the initial learning curve, transurethral Holmium laser resection of the prostate is a promising method of treatment for BPH as sh own by the increase flow and decrease in detrusor pressure. Although it doe s not yet rank equally with TUR-P, it is a less invasive alternative provid ing efficient, safe and almost bloodless treatment of BPH.