Holmium laser ablation of the prostate (HoLAP): intermediate-term results of 144 patients.
OBJECTIVE
To retrospectively analyse the intermediate-term outcome of holmium laser ablation of the prostate (HoLAP) of up to 4 years postoperatively in one of the largest series and to define the selection criteria for patients who benefit from potentially lower complications associated with HoLAP.


METHODS
Between June 2006 and November 2010, 144 patients with benign prostatic obstruction were treated at two centres with standardised HoLAP (2.0 J/50 Hz or 3.2 J/25 Hz with Versapulse(®) 80-100 W laser Lumenis(®)). Median follow-up was 21 months (range, 1-54). International prostate symptom score and quality of life (IPSS-QoL), PSA, prostate volume, maximal flow rate (Qmax), postvoiding residual volume (Vres) were evaluated pre- and postoperatively. All complications were graded according to CTCAE (v4.03).


RESULTS
Mean patient age was 70.1 ± 7.7 years (range, 46-90). With a preoperative median prostate volume of 40 ml (range, 10-130), the median operation time was 50 min (range, 9-138). We observed a median catheterisation time of 1 day (range, 0-12) and hospitalisation time of 2 days (range, 1-16). IPSS-QoL, Qmax and Vres were significantly improved after 3 months, and all parameters remained unchanged after 12, 24 and 36 months. The rate of re-operation was significantly lower in patients with prostate volume <40 ml, compared to patients with prostates ≥ 40 ml (9.1 vs. 25 %, p = 0.04).


CONCLUSIONS
HoLAP is a safe and effective procedure for the treatment of prostates <40 ml. Patients benefit from HoLAP because of a low bleeding rate and short hospital stay. Due to high recurrence rates, HoLAP should be avoided in prostates >40 ml.
Department of Urology, Duesseldorf University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany, dimitri.barski@med.uni-duesseldorf.de.
D
D
Barski
M
M
Richter
C
C
Winter
C
C
Arsov
P
P
de Geeter
R
R
Rabenalt
P
P
Albers
D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005500:Follow-Up Studies; D006695:Holmium; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
D006695:Holmium