Holmium Laser Enucleation of the Prostate for Glands Larger than 100 g: An Endourologic Alternative to Open Prostatectomy

Abstract

Treatment of the large (>100 g) prostatic adenoma often involves open prostatectomy, with its attendant risks and morbidity. Enucleation of the entire adenoma endoscopically is possible with the holmium:YAG laser and tissue removal from within the bladder by a transurethral tissue morcellator. These patients can usually be discharged from the hospital the following day without a catheter. A series of 43 patients with prostates 100 g was followed for 6 months after laser resection. The mean morcellation time was 16.1 minutes. The mean catheter time was 19.7 hours, and the mean hospital time was 28.4 hours. One patient required readmission for evacuation of tissue fragments. The average AUA Symptom Score declined from 23.5 preoperatively to 2.8 at 6 months postoperatively, and the mean Qmax increased from 9.0 mL/sec to 24.8 mL/sec. The holmium:YAG laser can be used to enucleate the adenoma in a large prostate in much the way the surgeon's finger does during open prostatectomy.