Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience

The holmium laser is a recent addition to the urologist's armamentarium, being used primarily for the destruction of urinary calculi. Its use as a tool for ablation of the prostate has not been previously described. Our initial experience with 110 patients who have undergone a combination procedure using the Nd:YAG laser for standard circumferential coagulation followed by holmium laser ablation is reported. A further 32 patients who have had a holmium-only technique are described. In the patients who had the combination technique, the AUA Symptom Score improved from a mean value of 19.8 preoperatively to 7.8 at 3 months. The peak urine flow rate likewise improved, from a mean of 8.9 mL/sec preoperatively to 15.1 mL/sec at 3 months. Only one patient who had the holmium-only technique required recatheterization, compared with nine patients who had the combination procedure. The combination Ho/Nd:YAG laser ablation technique is evolving. The early results of the holmium-only technique suggest an advantage over the combination with regard to catheterization time and degree of irritative symptoms. The longer-term results must be assessed to confirm this impression.