Holmium laser enucleation of the prostate for glands larger than 100 g: Anendourologic alternative to open prostatectomy

Background and Purpose: Treatment of the large (>100 g) prostatic adenoma o ften involves open prostatectomy, with its attendant risks and morbidity. E nucleation of the entire adenoma endoscopically is possible with the holmiu m:YAG laser and tissue removal from within the bladder by a transurethral t issue morcellator, These patients can usually be discharged from the hospit al the following day without a catheter, Patients and Methods: A series of 43 patients with prostates 100 g was foll owed for 6 months after laser resection. Results: The mean morcellation time was 16.1 minutes. The mean catheter tim e was 19.7 hours, and the mean hospital time was 28.4 hours, One patient re quired readmission for evacuation of tissue fragments. The average AUA Symp tom Score declined from 23.5 preoperatively to 2.8 at 6 months postoperativ ely, and the mean Q(max) increased from 9.0 mL/sec to 24.8 mL/sec. Conclusion: The holmium:YAG laser can be used to enucleate the adenoma in a large prostate in much the way the surgeon's finger does during open prost atectomy.