Holmium laser ablation of the prostate

Ablative laser methods for treating benign prostatic obstruction (BPO) have gained importance because of potentially lower complication rates than outpatient therapy methods. The aim of this prospective phase II study was to record the effectiveness and complications of holmium laser ablation of the prostate (HoLAP) in the first postoperative year. June 2006 to December 2007, 86 of 343 consecutive patients with BPO [International Prostate Symptom Score (IPSS) > 10] were treated with the VersaPulse 100-W laser (Lumenis), 2.0 J/50 Hz or 3.2 J/25 Hz. Preoperative and postoperative prostate-specific antigen (PSA), peak urinary flow rate (Q(max)), IPSS, prostate gland volume, and postvoid urine volume were prospectively measured. The median follow-up time was 8 months (3-21). Median patient age was 71 (50-83) years, and mean operating time was 77.5 (9-135) min. There was only one case of significant bleeding. In 14 of 86 cases (16%), HoLAP was combined with transurethral resection of the prostate (TURP). Short-term voiding complaints were expressed by 26.7% of the questioned patients. The length of hospital stay was in most cases < 48 h. IPSS, Q(max), PSA, postvoid urine, gland volumes, and quality of life improved significantly after 3 months, and all parameters remained unchanged after 12 months. The reoperation rate within 12 months was 6.8%. The advantage of HoLAP over TURP is the very low bleeding rate and thus a shorter hospital stay and possible outpatient therapy. In particular, patients with prostate gland volume < 50 ml profit from HoLAP. Postoperative voiding complaints are comparable to those with TURP. Long-term results are needed to confirm the low reoperation rate.