APPLICATION OF THE HOLMIUM-YAG LASER FOR PROSTATECTOMY

Objective: The authors review the current knowledge regarding the appl ication of the Holmium:YAG laser for prostatectomy, Summary Background Data: Conventional surgical therapies for benign prostatic hyperplasi a (BPH) are effective but associated with relatively high morbidity, L aser prostatectomy, using either Neodymium:YAG or potassium-titanyl-ph osphate lasers, has emerged as a new and much safer operative approach to relieve symptoms of benign prostatic hyperplasia. However, these l aser wavelengths possess key disadvantages that have limited their acc eptability and dissemination in everyday urologic practice. Methods: T he authors review their own extensive experience in the development an d clinical application of Holmium:YAG laser technology for prostatecto my, as well as the published reports in the current medical literature now dealing with this subject. Results: In multiple clinical trials, Holmium:YAG laser resection of the prostate has proven efficacious in relieving symptomatic BPH, Both objective urodynamic measures of voidi ng outcomes and symptomatic improvement have been shown to be equivale nt to standard electrocautery resection of the prostate, At the same t ime, these studies have demonstrated the superior safety and hemostasi s of Holmium:YAG laser prostatectomy compared to electrocautery resect ion, similar to prior laser prostatectomy procedures, Unlike prior for ms of laser prostatectomy, Holmium:YAG laser resection of the prostate acutely removes all obstructing prostate tissue, so that the postoper ative catheterization requirement is typically only overnight and impr ovement in voiding is immediate, Current operative techniques and the latest technological developments to facilitate Holmium:YAG laser pros tatectomy are described. Conclusions: Holmium:YAG laser prostatectomy combines the best features of prior laser prostatectomy technologies, including minimal complications and morbidity, with the efficacy and i mmediacy of voiding outcomes associated with conventional electrocaute ry resection of the prostate.