Holmium Laser Ablation of the Prostate Versus Photoselective Vaporization of Prostate 60 cc or Less: Short-Term Results of a Prospective Randomized Trial

Purpose

We report on the first randomized trial to our knowledge comparing holmium laser ablation and photoselective vaporization of the prostate in patients with a small to moderate size prostate.

Materials and Methods

Between March 2005 and April 2007, 109 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia and prostate size 60 cc or smaller were randomized to photoselective vaporization of the prostate (52) or holmium laser ablation of the prostate (57). All patients were evaluated by preoperative and postoperative International Prostate Symptom Score, peak flow rate and post-void residual urine volume, measurement of prostate specific antigen and transrectal ultrasound prostate volume. Followup evaluations were performed during visits at 1, 3, 6 and 12 months.

Results

Mean ± SD preoperative prostate volume was 33.1 ± 14.5 and 37.3 ± 13.6 cc in the holmium laser ablation group and the photoselective vaporization group, respectively. Holmium laser ablation of the prostate required more operating time than photoselective vaporization (69.8 vs 55.5 minutes, p = 0.008). In the holmium laser ablation group the International Prostate Symptom Score improved from 20 ± 6.8 to 6.2 ± 3.9 and peak urinary flow rate increased from 6.7 ± 3.9 to 17.2 ± 8 ml per second. In the photoselective vaporization group the International Prostate Symptom Score improved from 18.4 ± 6.6 to 8.2 ± 6.2 and peak urinary flow rate increased from 6.4 ± 3.9 to 18.4 ± 8.4 ml per second. Urethral stricture rates were 1.7% vs 5.7%, bladder neck contractures were 3.5% vs 7.7% and revaporization rates were 3.5% vs 1.9% in the holmium laser ablation and photoselective vaporization groups, respectively.

Conclusions

Holmium laser ablation and photoselective vaporization of the prostate are safe and effective in patients with benign prostatic hyperplasia with a small to moderate size prostate. Both procedures are easy to learn but holmium laser ablation of the prostate requires a longer operating time.

Key Words: lasers, solid-state, transurethral resection of prostate, ablation techniques, prostatic hyperplasia, prostatectomy

Abbreviations and Acronyms: BNC, bladder neck contactures, BPH, benign prostatic hyperplasia, HoLAP, holmium laser ablation of the prostate, IIEF, International Index of Erectile Function, I-PSS, International Prostate Symptom Score, LUTS, lower urinary tract symptoms, PSA, prostate specific antigen, PVP, photoselective vaporization of the prostate, PVR, post-void residual urine, Qmax, peak urinary flow rate, QoL, quality of life, TRUS, transrectal ultrasound, TURP, transurethral resection of the prostate