Holmium: YAG Laser Resection of the Prostate Versus Visual Laser Ablation of the Prostate and Transurethral Ultrasound‐Guided Laser Induced Prostatectomy: A Retrospective Comparative Study

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Abstract
Background: Transurethral resection of the prostate (TUR‐P) is the gold standard for treating symptomatic benign prostatic hyperplasia (BPH) despite some perioperative morbidity. As a minimally‐invasive alternative to TUR‐P, a neodymium:YAG laser, and more recently a holmium:YAG laser, have been used in transurethral surgery for BPH. In order to assess the safety and efficacy of various BPH treatments, the outcome in patients treated with transurethral ultrasound‐guided laser induced prostatectomy (TULIP), visual laser ablation of the prostate (VLAP) and holmium:YAG laser resection of the prostate (HoLRP) were retrospectively compared. Methods: From May 1995 to August 1996, 60 patients with symptomatic BPH underwent TULIP (n=20), VLAP (n=20), and HoLRP (n=20). All patients were evaluated preoperatively and at 1 and 3 months postoperatively by the International Prostate Symptom Score (IPSS), the IPSS quality‐of‐life score (QOL), maximum flow rate (MFR), prostate volume, and residual urine volume. Results: The preoperative mean IPSS was 18.5, 19.3, and 19.6 and the mean MFR was 6.3, 6.9, and 6.1mL/sec in the TULIP, VLAP, and HoLRP groups, respectively. At 1 month after surgery, the mean IPSS was 10.2, 9.5, and 4.7 and the mean MFR was 9.6, 1 3.4, and 1 8.7mL/sec while at 3 months the mean IPSS was 6.2, 6.1, and 3.6 and the mean MFR was 14.1, 1 6.0, and 21.5 mL/sec in patients treated with TULIP, VLAP, and HoLRP, respectively. No serious complication occurred in any patient. Conclusion: Although HoLRP requires expertise, it appears to be a promising treatment modality for BPH.