title: Simultaneous holmium laser enucleation of prostate and upper-tract endourologic stone procedures.
abstract: OBJECTIVE
  The holmium laser is a versatile urologic tool. Its unique cutting and coagulating properties allow multiple procedures, such as stone fragmentation and laser enucleation of the prostate (HoLEP), to be performed with a single set-up. This paper reviews our experience with simultaneous HoLEP and endourologic upper-tract stone procedures.
  
  
  METHODS
  We retrospectively reviewed all 11 patients (12 renal units) treated with the combined approach of HoLEP and an upper-tract endourologic procedure for stone disease. All patients initially underwent HoLEP, followed immediately by percutaneous nephrolithotomy (PCNL)(N=2), ureteroscopy (URS)(N=8), or both (N=1). The mean stone diameter was 34.7 mm for PCNL and 6.7 mm for URS. Outcome data and complications were recorded.
  
  
  RESULTS
  The mean preoperative and postoperative American Urological Association Symptom Scores were 21.8 and 6.3, respectively. The mean prostatic specimen weight was 118 g (range 21-376 g), and the mean hospital stay was 1.4 days. For 10 patients with available prostatic specific antigen (PSA) data, the mean preoperative and postoperative values were 6.2 and 0.9 ng/mL, respectively. All patients were catheter free at discharge. All three PCNL patients were rendered stone free; all four URS patients who had radiographic follow-up were stone free. There were no short- or long-term complications, and no transfusions were necessary.
  
  
  CONCLUSIONS
  Simultaneous HoLEP and laser lithotripsy are feasible, emphasizing the unique capabilities of the holmium laser. The hemostasis offered by HoLEP allows safe removal of prostatic tissue and urinary calculi, obviating multiple procedures.
authors.affiliation: Methodist Hospital Institute for Kidney Stone Disease and Indiana University School of Medicine, Indianapolis, Indiana, USA. samckim@iupui.edu
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Kim
authors.forename: William W
authors.initials: WW
authors.lastname: Tinmouth
authors.forename: Ramsay L
authors.initials: RL
authors.lastname: Kuo
authors.forename: Ryan F
authors.initials: RF
authors.lastname: Paterson
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D053685:Laser Therapy; D008297:Male; D009403:Nephrostomy, Percutaneous; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000379:methods*; D018666:Ureteroscopy; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery