BACKGROUND: Transurethral resection of the prostate (TURP) is the gold standard for treating symptomatic benign prostatic hyperplasia (BPH) despite some perioperative morbidity. As a minimally-invasive alternative to TURP, 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 (Qmax), prostate volume, and residual urine volume.

RESULTS: The preoperative mean IPSS was 18.5, 19.3, and 19.6 and the mean Qmax was 6.3, 6.9, and 6.1 mL/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 Qmax was 9.6, 13.4, and 18.7 mL/sec while at 3 months the mean IPSS was 6.2, 6. 1, and 3.6 and the mean MFR was 14.1, 16.0, 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.

Journal of Endourology, Vol.5, Number 2, 152-156, Mar 1998