The Results of Holmium Laser Resection of the Prostate (HoLRP) for BPH
Chilton C, Speake W

INTRODUCTION: The development of the 80 watt Holmium Yag laser has enabled bloodless resection of the prostate for BPH to be possible and practical.

PATIENTS AND METHODS: Since October 1996, 208 patients (mean age 66 years) have undergone elective HOLRP. Peak urinary flow rates (Qmax), IPSS symptom scores, and duration of catheterisation and hospital stay from admission to discharge catheter free were used as outcome measures. Using a bare fibre technique the prostate was resected in the capsular plane. Large pieces of tissue were reduced in size and then pulled or washed from the bladder, followed by insertion of a 20CH 2 way silicone catheter. After discharge, patients were seen at 1, 6 and 12 months when IPSS, Qmax and all complications were recorded.

RESULTS. There were no perioperative deaths nor cases of TUR syndrome. Two patients have required blood transfusion and two have had a significant secondary haemorrhage. The mean time of catheterisation was 1.6 days, and mean hospital stay 2.98 days. The mean IPSS decreased from 21.0 pre-operatively to 7.0 at one year whilst Qmax increased from 10.69 mL/sec to 20.52 mL/sec.

CONCLUSION: Using HOLRP, the prostate can be accurately resected down to the capsule with minimal bleeding, little fluid absorption or secondary haemorrhage. The irritative symptoms are similar to those seen with TURP, but significantly less than those noticed after VLAP using the Nd Yag laser. These early results are equivalent to TURP in symptomatic relief and improvement of Qmax. HOLRP is safer than TURP, with a shorter hospital stay and convalescence and offers a better quality of surgical care for our patients.

Journal of Endourology, Vol. 13 Supplement 1, A98, Sep 1999

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