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

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Abstract
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. 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. 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. 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.