Histologic effects of Holmium : YAG laser resection versus transurethral resection of the prostate

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.