A. Das et al., Histologic effects of Holmium : YAG laser resection versus transurethral resection of the prostate, J ENDOUROL, 14(5), 2000, pp. 459-462
Background and Purpose: Holmium laser resection (HoLRP) is an effective sur
gical alternative to transurethral resection of the prostate (TURP), We inv
estigated whether an adequate histologic diagnosis could be made from HoLRP
tissue specimens.
Patients and Methods: A series of 120 patients were randomized to TURF (N =
59) or HoLRP (N = 61), Each histologic specimen was reviewed by a single p
athologist, who was blinded to the treatment. Weight of tissue, histologic
diagnosis, and degree of thermal artifact were assessed. Thermal damage was
graded as follows: 1 = no significant thermal injury; 2 = <25% of the tiss
ue damaged (minimal); 3 = 25% to 80% of the tissue damaged (moderate); and
4 = >80% of the tissue damaged, with loss of prostatic architecture (extens
ive),
Results: The mean weight of the TURF and HoLRP specimens was 15.6 g and 9.6
g, respectively. The mean grade of thermal artifact for the TURF group was
1.8 and for the HoLRP group 2.6. Of the HoLRP specimens, 56 (92%) were gra
de less than or equal to 3. Of the entire series of 120 specimens, 5 contai
ned malignant tissue, all of which were from the TURF group. Four of these
specimens were adenocarcinoma of the prostate, whereas the other was a tran
sitional-cell carcinoma. Of the four specimens that contained prostate canc
er, two were stage pT1(a) tumors,
Conclusions: Although identifiable prostatic architecture was maintained in
the majority of histologic specimens from the HoLRP group, the tissue qual
ity was inferior to that of TURF. There was significantly more vaporization
and subsequent tissue loss with HoLRP, and the thermal damage to tissue wa
s greater.