Holmium laser ablation and enucleation of the prostate: a pilot study of the hybrid technique
Helfand T. Brian; Manvar M. Ankur; Auffenberg B. Gregory; Blackwell Robert; Hartman J. Robert; McVary T. Kevin;
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
OBJECTIVES: To report the initial clinical experience using a hybrid technique combining holmium laser ablation of the prostate (HoLAP) and holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).METHODS: A total of 18 patients with documented moderate to severe LUTS underwent the hybrid technique. Baseline characteristics were documented for all patients. Operative and resection times, as well as intra and perioperative complications, were recorded. Additionally, changes in American Urological Association symptom index (AUA-SI) and quality of life (QoL) scores and serum prostate-specific antigen (PSA) values were recorded both pre and postoperatively. RESULTS: All patients experienced significant improvements in their AUA-SI and QoL scores, with a mean decrease in PSA of 74.6% postoperatively. There were no reported complications with this technique and the average resection time (48.2 min) was decreased in comparison to those reported for HoLAP or HoLEP monotherapies. CONCLUSIONS: This is the first report of surgical therapy for BPH involving two different holmium laser therapies. This hybrid technique offers tissue for pathologic analysis in comparison to HoLAP, and an improved learning curve and decreased complication rate in comparison to HoLEP. Additional studies are warranted to validate this data.