Holmium laser for the surgical treatment of benign prostatic hyperplasia

Holmium laser ablation of the prostate (HoLAP) is a surgical approach for treatment of benign prostatic hyperplasia (BPH). Limited evidence suggests laser ablation/vaporization is inferior to enucleation with respect to reoperation rates. Our objective was to determine if properly performed laser ablation results in outcomes similar to enucleation.

A total of 198 patients with moderate to severe lower urinary tract symptoms and/or acute urinary retention had holmium laser enucleation of the prostate (HoLEP) or HoLAP between 2008 and 2014. Patients with metastatic prostate cancer, prior pelvic radiation, or bladder cancer involving the bladder neck or prostatic urethra were excluded. All procedures involved residents and were supervised by one experienced surgeon. The decision to perform HoLAP versus HoLEP was made intraoperatively. Demographics, pre, peri and postoperative data were collected.

A total of 169 men were analyzed: 54 had HoLAP and 115 had HoLEP. Mean follow up was 27.16 months for HoLAP, and 38.18 months for HoLEP. As expected, the HoLEP group had larger prostates, longer mean operative times, and greater reduction in total PSA. There was no difference in the net change of flow rate between groups.

Both HoLEP and HoLAP are appropriate surgical interventions for the management of BPH, when properly performed. Our findings suggest that adequate ablation of prostatic adenoma results in similar 2 year outcomes as enucleation.