TRANSURETHRAL HOLMIUM LASER RESECTION OF THE PROSTATE (HOLRP) AND HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)

Holmium: YAG laser resection of the prostate (HoLRP) and Holmium: YAG laser enucleation of the prostate (HoLEP) are effective therapies of B PH, but still relatively unknown in the FRC. Therefore, the technology , operative technique, clinical results, advantages and disadvantages and future developments are described and discussed. In contrast to th e low water absorption and the 10-20 fold deeper tissue penetration of the neodymium (Nd): YAG laser, the wave-length of the Holmium (Ho): Y AC laser is strongly absorbed by water and the tissue absorption lengt h of 0.4 mm is very shallow. Therefore, with direct tissue contact (ba re-fiber-technique) prostatic tissue can be vaporised and cut very wel l, with significantly reduced bleeding and without invisible deep tiss ue injuries. As with classical TURF, HoLRP and HoLEP immediately remov e obstructing prostatic tissue, under direct visual control. That diff ers from visual laser ablation (VLAP) or interstitial laser coagulatio n (ILC), both of which only induce coagulation necrosis that has to be dissolved over weeks to months. Clinical studies clearly showed that HoLRP and HoLEP produced significantly better results than Nd: YAG VLA P. The comparison with classical TURF revealed the improvement of mict urition, the reduction of symptoms and the weight of resected tissue t o be almost identical with all techniques. Postoperative catheterisati on and hospital stay with HoLRP and HoLEP were significantly shorter, only the operating time was longer. Disadvantages of the HoLRP and HoL EP are a pronounced learning curve, even for an experienced endourolog ist, and the high purchase costs of the laser, which can be reduced by joint use and financing by urologists and orthopaedic surgeons. Altho ugh there are relatively few long-term results, HoLRP and HoLEP can al ready be viewed as a promising alternative to classical TURF with simi lar results and a significant reduction of blood loss, catheter time a nd hospital stay.