British Journal of Urology (1998), 81, 518–519 The results of holmium laser resection of the prostate M.J. MACKEY, C.P. CHILTON, P.J. GILLING*, M. FRAUNDORFER*and M.D. CRESSWELL† Derby City General Hospital, Derby, UK, *Tauranga Hospital and †Rotorua Hospital, New Zealand Objective To assess the results of holmium–laser resec- Results There was a large and sustained improvement in symptom scores and urinary flow rates, with no tion of the prostate (HOLRP) in the treatment of benign prostatic hyperplasia. mortality and low morbidity. Conclusion We recommend this technique as an alterna- Patients and methods Between 1994 and 1997, 967 patients underwent HOLRP in Tauranga, New tive to transurethral resection in the surgical treat- ment of bladder outlet obstruction due to benign Zealand, and in Derby, United Kingdom. The patients were followed at 1, 3 and 6 months after treatment prostatic hypertrophy. Keywords Benign prostatic hyperplasia, holmium laser using measurements of symptom score and urinary flow rate. resection of the prostate Peri-operatively, the duration of the operation, laser Introduction energy used, weight of tissue resected, duration of cath- eterization and hospital stay, and any complications The holmium laser is emerging as a versatile multi- purpose tool in urology; it is becoming accepted as were recorded. The standard practice was to leave a two-way silicone catheter in place overnight; this was the modality of choice for intracorporeal lithotripsy of urinary calculi [1,2]. It also has many soft-tissue removed the next morning and the patients discharged that day once satisfactory voiding was established. The applications in urology [3] and is now being used to perform prostatic resection. The wavelength (2.1 mm) standard clinical follow-up comprised an estimate of the AUA score and Q max at 1, 3 and 6 months after surgery. and tissue-absorption characteristics (0.44 mm) of the holmium laser allow endoscopic delivery by bare fibre, In all, 967 patients underwent HOLRP (mean age 69 years, range 44–89) and the mean prostate volume was and precise cutting and vaporization of prostate tissue in an almost bloodless field. The development of the 52 mL (range 10–200). higher power laser (60–80 W, Versapulse Select by Coherent, UK) and refinement of the resection technique Results has enabled a rapid and safe prostatic resection; we report our experience in 967 patients. The mean (range) duration of the operation was 43 (5–140) min, the laser energy used 86 (48–342) kJ and the mean weight of tissue resected 8 (1–62) g. The mean Patients and methods (range) duration of catheterization was 1.5 (0.5–21) days and the mean hospital stay 1.1 days. There were The current technique of holmium-laser resection of the prostate (HOLRP) was developed in 1994 in Tauranga, no peri-operative deaths or cases of TUR syndrome. Two patients required a blood transfusion, two required New Zealand by Gilling et al. and has been described previously [4]. Slight variations in operative technique re-catheterization because of secondary bleeding (one patient was anticoagulated). The post-operative irritative have developed but all methods essentially enucleate the prostate at the level of the surgical capsule, resulting in symptoms were similar to those occurring after TURP and significantly less than after Nd:YAG coagulation a cavity identical to that produced during TURP. All patients underwent a routine pre-operative assessment prostatectomy [5]. Table 1 shows the Q max and AUA scores before and after surgery; there was a large and using symptom scoring (AUA) and a measurement of peak urinary flow rate (Q max ); in addition most patients sustained improvement in both variables after treatment. The magnitude of improvement in these variables was had their prostate volume estimated from TRUS. similar to that expected with TURP by electrosurgery. Accepted for publication 16 December 1997 518 © 1998 British Journal of Urology