Transurethral Holmium Laser Enucleation Versus Transvesical Open Enucleation for Prostate Adenoma Greater Than 100 gm.: A Randomized Prospective Trial of 120 Patients

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Oct 2002Transurethral Holmium Laser Enucleation Versus Transvesical Open Enucleation for Prostate Adenoma Greater Than 100 gm.: A Randomized Prospective Trial of 120 Patients Rainer M. Kuntz and Karin Lehrich Rainer M. KuntzRainer M. Kuntz More articles by this author and Karin LehrichKarin Lehrich More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64475-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Prostate adenomas greater than 100 gm. have traditionally been treated with open prostatectomy. This procedure may involve considerable blood loss, morbidity, prolonged hospital stay and recovery time. The high powered holmium:YAG laser can be used endoscopically to enucleate obstructing prostatic tissue in a relatively bloodless manner. The technique of transurethral holmium laser enucleation of the prostate is compared to open prostatectomy for the surgical management of large prostate adenomas in a prospective randomized study. Materials and Methods: A total of 120 urodynamically obstructed patients with a prostate larger than 100 gm. on transrectal ultrasound were randomized to undergo holmium laser enucleation of the prostate or open prostatectomy. All patients were assessed preoperatively and 1, 3 and 6 months postoperatively. Patient baseline characteristics, perioperative data and postoperative outcome were compared. All complications were noted. Results: Holmium laser enucleation of the prostate and open prostatectomy resulted in a similar and significant improvement in American Urological Association symptom scores, peak urinary flow rates and post-void residual urine volumes. Operating time was significantly longer in the holmium group but blood loss was significantly less, and catheterization time and hospital stay were significantly shorter. Effects on continence and potency were similar in both groups but adverse events were less frequent in the holmium group. None of the holmium group patients needed blood transfusions in contrast to 8 patients in the prostatectomy group. Conclusions: Holmium laser enucleation of the prostate and open prostatectomy are equally effective procedures for removal of large prostatic adenomas. Holmium laser enucleation resulted in significantly less perioperative morbidity and may become the endourological alternative to open prostatectomy. References 1 : Holmium laser enucleation for prostate adenoma greater than 100 gm.: comparison to open prostatectomy. J Urol2001; 165: 459. Link, Google Scholar 2 : Laser prostatectomy with the holmium: YAG laser. Tech Urol1995; 1: 217. Medline, Google Scholar 3 : Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology1996; 47: 48. Crossref, Medline, Google Scholar 4 : Transurethrale holmium-laser-resektion der prostata (HoLRP) und holmium-laser-enukleation der prostata (HoLEP). Akt Urol1998; 29: 139. Crossref, Google Scholar 5 : The use of the holmium laser in the treatment of benign prostatic hyperplasia. J Endourol1996; 10: 459. Crossref, Medline, Google Scholar 6 : Holmium: YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol1998; 33: 69. Crossref, Medline, Google Scholar 7 : Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol1998; 12: 457. Crossref, Medline, Google Scholar 8 : Holmium laser resection of the prostate. J Endourol1998; 12: 279. Crossref, Medline, Google Scholar 9 : Transurethral resection of the prostate with the holmium contact laser. Progress in treatment of benign prostatic hypertrophy? Urologe A1999; 38: 156. Google Scholar 10 : Results of holmium laser resection of the prostate for benign prosta