Skip to main content
Top
Published in: Current Bladder Dysfunction Reports 4/2011

01-12-2011 | Voiding Dysfunction (Craig V. Comiter, Section Editor)

Holmium Laser Approaches to Symptomatic Benign Prostatic Hyperplasia

Authors: Andrew C. Boylan, Lori B. Lerner

Published in: Current Bladder Dysfunction Reports | Issue 4/2011

Login to get access

Abstract

The holmium laser is a well-established instrument in the treatment of a variety of urologic conditions. Treatment of benign prostatic hyperplasia (BPH) with the holmium laser has grown steadily over the past decade, with multiple studies demonstrating its role as an effective alternative to other transurethral and open surgical treatments of BPH. This review describes current surgical techniques that employ the holmium laser and surveys recent literature comparing holmium-based treatments with traditional transurethral techniques, with particular attention paid to holmium laser enucleation of the prostate. Recent studies continue to support the short- and long-term efficacy of holmium laser enucleation of the prostate and other holmium-based treatments, providing evidence for the laser’s growing use in the treatment of benign obstruction. Transurethral surgery with the holmium laser endures as an effectual treatment for BPH that offers excellent, lasting functional outcomes with favorable short- and long-term morbidity when compared with conventional transurethral techniques.
Literature
1.
go back to reference Gilling PJ, Cass CB, Malcolm AR, et al. Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J Endourol. 1995;9(2):151–3.PubMedCrossRef Gilling PJ, Cass CB, Malcolm AR, et al. Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J Endourol. 1995;9(2):151–3.PubMedCrossRef
2.
go back to reference • Lerner LB, Tyson MD. Holmium laser applications of the prostate. Urol Clin N Am. 2009;36:485–95. This article provides descriptions of the surgical techniques and a detailed discussion of published literature covering many different aspects of HoLAP and HoLEP. CrossRef • Lerner LB, Tyson MD. Holmium laser applications of the prostate. Urol Clin N Am. 2009;36:485–95. This article provides descriptions of the surgical techniques and a detailed discussion of published literature covering many different aspects of HoLAP and HoLEP. CrossRef
3.
go back to reference Lourenco T, Shaw M, Fraser C, et al. The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials. World J Urol. 2010;28:23–32.PubMedCrossRef Lourenco T, Shaw M, Fraser C, et al. The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials. World J Urol. 2010;28:23–32.PubMedCrossRef
4.
go back to reference Aho TF, Gilling PJ, Kennett KM, et al. Holmium laser bladder neck incision versus holmium enucleation of the prostate as outpatient procedures for prostates less than 40 grams. J Urol. 2005;174(1):210–4.PubMedCrossRef Aho TF, Gilling PJ, Kennett KM, et al. Holmium laser bladder neck incision versus holmium enucleation of the prostate as outpatient procedures for prostates less than 40 grams. J Urol. 2005;174(1):210–4.PubMedCrossRef
5.
go back to reference Elzayat EA, Majid AS, Khalaf A, et al. Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: short-term results of a randomized trial. J Urol. 2009;182:133–8.PubMedCrossRef Elzayat EA, Majid AS, Khalaf A, et al. Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: short-term results of a randomized trial. J Urol. 2009;182:133–8.PubMedCrossRef
6.
go back to reference Te AE, Lee R. Holmium laser enucleation of the prostate: an evolving prostatectomy technique. J Urol. 2010;184(2):641–2.PubMedCrossRef Te AE, Lee R. Holmium laser enucleation of the prostate: an evolving prostatectomy technique. J Urol. 2010;184(2):641–2.PubMedCrossRef
7.
go back to reference • Elmansy HM, Elzayat E, Elhilali MM. Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: long term results of a randomized trial. J Urol. 2010;184(5):2023–8. The most commonly used laser technique, PVP, is compared with HoLAP in this study. As many urologists have used PVP and often have thoughts regarding HoLAP without direct experience with the technique, this study provides some data from which to generate an opinion. PubMedCrossRef • Elmansy HM, Elzayat E, Elhilali MM. Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: long term results of a randomized trial. J Urol. 2010;184(5):2023–8. The most commonly used laser technique, PVP, is compared with HoLAP in this study. As many urologists have used PVP and often have thoughts regarding HoLAP without direct experience with the technique, this study provides some data from which to generate an opinion. PubMedCrossRef
8.
go back to reference Kumar SM. Rapid communication: holmium laser ablation of large prostate glands: an endourologic alternative to open prostatectomy. J Endourol. 2007;21:659–62.PubMedCrossRef Kumar SM. Rapid communication: holmium laser ablation of large prostate glands: an endourologic alternative to open prostatectomy. J Endourol. 2007;21:659–62.PubMedCrossRef
9.
go back to reference Kollmeier MA, Stock RG, Cesaretti J, et al. Urinary morbidity and incontinence following transurethral resection of the prostate after brachytherapy. J Urol. 2005;173:808–12.PubMedCrossRef Kollmeier MA, Stock RG, Cesaretti J, et al. Urinary morbidity and incontinence following transurethral resection of the prostate after brachytherapy. J Urol. 2005;173:808–12.PubMedCrossRef
10.
go back to reference Helfand BT, Manvar AM, Auffenberg GB, et al. Holmium laser ablation and enucleation of the prostate: a pilot study of the hybrid technique. Can J Urol. 2010;17(3):4933–7. Helfand BT, Manvar AM, Auffenberg GB, et al. Holmium laser ablation and enucleation of the prostate: a pilot study of the hybrid technique. Can J Urol. 2010;17(3):4933–7.
11.
go back to reference Dusing MW, Krambeck AE, Terry C, et al. Holmium laser enucleation of the prostate: efficiency gained by experience and operative technique. J Urol. 2010;184(2):635–40.PubMedCrossRef Dusing MW, Krambeck AE, Terry C, et al. Holmium laser enucleation of the prostate: efficiency gained by experience and operative technique. J Urol. 2010;184(2):635–40.PubMedCrossRef
12.
go back to reference • Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2010;183:1105–9. This is the largest US experience of HoLEP, which includes 5-year follow-up for a small cohort of patients. PubMedCrossRef • Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2010;183:1105–9. This is the largest US experience of HoLEP, which includes 5-year follow-up for a small cohort of patients. PubMedCrossRef
13.
go back to reference Gilling PJ, Aho TF, Frampton CM, et al. Holmium laser enucleation of the prostate: results at 6 years. Eur Urol. 2008;53(4):744–9.PubMedCrossRef Gilling PJ, Aho TF, Frampton CM, et al. Holmium laser enucleation of the prostate: results at 6 years. Eur Urol. 2008;53(4):744–9.PubMedCrossRef
14.
go back to reference Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5 year follow-up results of a randomized clinical trial. Eur Urol. 2008;53:160–8.PubMedCrossRef Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5 year follow-up results of a randomized clinical trial. Eur Urol. 2008;53:160–8.PubMedCrossRef
15.
go back to reference Elzayat EA, Elhilali MF. Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol. 2007;52:1465–72.PubMedCrossRef Elzayat EA, Elhilali MF. Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol. 2007;52:1465–72.PubMedCrossRef
16.
go back to reference •• Ahyai SA, Gilling P, Kaplan SA et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58:384–97. This article was authored by experts in BPH surgery, including TURP, bipolar techniques, HoLEP, and PVP. Included in the meta-analysis were 27 publications involving 23 different randomized controlled trials with a total of 2,245 patients and 1b level of evidence for all included studies. It examined outcomes and complications and compared the approaches. PubMedCrossRef •• Ahyai SA, Gilling P, Kaplan SA et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58:384–97. This article was authored by experts in BPH surgery, including TURP, bipolar techniques, HoLEP, and PVP. Included in the meta-analysis were 27 publications involving 23 different randomized controlled trials with a total of 2,245 patients and 1b level of evidence for all included studies. It examined outcomes and complications and compared the approaches. PubMedCrossRef
17.
go back to reference Eaton SH, Lerner LB. Cost analysis of surgical approaches for bladder outlet obstruction: laser versus loop. Presented at the Annual Meeting of the American Urological Association, San Francisco, CA; May 2010. Eaton SH, Lerner LB. Cost analysis of surgical approaches for bladder outlet obstruction: laser versus loop. Presented at the Annual Meeting of the American Urological Association, San Francisco, CA; May 2010.
18.
go back to reference Bae J, Oh SJ, Paick JS. The learning curve for Holmium laser enucleation of the prostate: a single-center experience. Kor J Urol. 2010;51:688–93.CrossRef Bae J, Oh SJ, Paick JS. The learning curve for Holmium laser enucleation of the prostate: a single-center experience. Kor J Urol. 2010;51:688–93.CrossRef
19.
go back to reference Lerner LB, Tyson MD, Mendoza PJ. Stress incontinence during the learning curve of Holmium laser enucleation of the prostate. J Endourol. 2010;24(10):1655–8.PubMedCrossRef Lerner LB, Tyson MD, Mendoza PJ. Stress incontinence during the learning curve of Holmium laser enucleation of the prostate. J Endourol. 2010;24(10):1655–8.PubMedCrossRef
Metadata
Title
Holmium Laser Approaches to Symptomatic Benign Prostatic Hyperplasia
Authors
Andrew C. Boylan
Lori B. Lerner
Publication date
01-12-2011
Publisher
Current Science Inc.
Published in
Current Bladder Dysfunction Reports / Issue 4/2011
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-011-0101-z

Other articles of this Issue 4/2011

Current Bladder Dysfunction Reports 4/2011 Go to the issue

Voiding Dysfunction (Craig V. Comiter, Section Editor)

Lower Urinary Tract Symptoms Associated with Male Urologic Pelvic Pain Syndrome

Voiding Dysfunction (Craig V. Comiter, Section Editor)

Management of Bladder Diverticula

Voiding Dysfunction (Craig V. Comiter, Section Editor)

Detrusor-Directed Therapy in Men With Benign Prostatic Hyperplasia

Voiding Dysfunction (Craig V. Comiter, Section Editor)

An Update on Neuromodulation for Voiding Dysfunction

Voiding Dysfunction (Craig V. Comiter, Section Editor)

Management of the Failed Transurethral Resection of the Prostate