Holmium:YAG laser prostatectomy: results of U.S. pilot study

The holmium:YAG (Ho:YAG) laser wavelength's ability to vaporize and incise soft tissue offers potential advantages for prostatectomy compared with the Nd:YAG laser, which primarily produces tissue coagulation. In this initial U.S. trial, Ho:YAG laser prostatectomy was performed in 20 men, including 2 men treated immediately prior to radical prostatectomy to assess Ho:YAG laser tissue effects in the prostate. A total of 18 men were treated for clinically symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH). Estimated excess BPH tissue averaged 24 g (range 5-50 g). A mean of 129 kJ of Ho:YAG laser energy was delivered, combined with a mean of 11 kJ of Nd:YAG energy to provide supplemental coagulation for hemostasis. The mean operative time was 1 hour 34 minutes. No significant intraoperative changes in hematocrit or serum electrolytes were documented. No perioperative or late complications occurred. The mean postoperative catheterization time was 1.4 days. Of the 18 patients, 16 (90%) underwent a successful voiding trial on the first postoperative morning. Immediate improvement in voiding, comparable to that seen after transurethral electrocautery resection of the prostate (TURP), was reported by all patients. Ho:YAG laser resection of the prostate appears to be a useful surgical technique associated with minimal morbidity and immediate improvement in voiding.