title: Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate.
abstract: OBJECTIVE
  We assess the perioperative, short-term and long-term functional outcomes of treating bladder outlet obstruction secondary to a small prostate by 1 of 2 laser techniques.
  
  
  METHODS
  A retrospective review using a prospectively maintained database was performed of patients treated for bladder outlet obstruction secondary to a prostate smaller than 40 ml. Patients who were treated with GreenLight™ photoselective vaporization of the prostate or holmium laser transurethral incision of the prostate were included in the study.
  
  
  RESULTS
  From January 2002 through December 2010, 191 cases of 1,682 laser prostate surgeries were described. GreenLight photoselective vaporization of the prostate was performed in 144 (75.4%) cases and holmium laser transurethral incision of the prostate was performed in 47 (24.6%) cases. A significantly shorter mean operating time, hospital stay and catheter duration were observed in the holmium laser transurethral incision of the prostate group (30.3 ± 16 minutes, 0.8 ± 0.8 days and 1.3 ± 1.9 days, respectively) than in the photoselective vaporization of the prostate group (45.8 ± 22 minutes, 0.3 ± 0.4 days and 0.4 ± 0.6 days, respectively, p <0.05). At 1 and 5 years after photoselective vaporization of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement in mean maximal flow rate of 57.7% and 62.8%, 58.3% and 57.2%, 65.4% and 73%, and 127.6% and 167.1%, respectively. At 1 and 5 years after holmium laser transurethral incision of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement of mean maximal flow rate of 55.3% and 52.8%, 49.2% and 49%, 45% and 78.1%, and 67.4% and 35.4%, respectively. Subjective and objective urine flow parameters were comparable at different followup points. There was no significant difference between the 2 groups in terms of early and late complications (p >0.05). Reoperation rates were 10.4% and 6.4% in the photoselective vaporization of the prostate and holmium laser transurethral incision of the prostate groups, respectively (p >0.05). The mean estimated cost per holmium laser transurethral incision of the prostate procedure was significantly lower than per photoselective vaporization of the prostate procedure (509.34CAD vs 1,765.92CAD, p = 0.002).
  
  
  CONCLUSIONS
  Holmium laser transurethral incision of the prostate and GreenLight photoselective vaporization of the prostate seem to be equally effective, safe and durable surgical treatment options for small prostates even in high risk patients.
authors.affiliation: Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.affiliation: Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada; Urology Department, Suez Canal University, Ismailia, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.affiliation: Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Hazem M
authors.initials: HM
authors.lastname: Elmansy
authors.affiliation: Division of Epidemiology & Biostatistics, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Sampalis
authors.affiliation: Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada. Electronic address: mostafa.elhilali@muhc.mcgill.ca.
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Elhilali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery*
keywords: BNC; BOO; BPH; CAD; Canadian dollars; HoLEP; Hol; I-PSS; International Prostate Symptom Score; KTP; LBO; PVP; PVR; QOL; Qmax; TOV; TRUS; TUIP; TURP; YAG; benign prostatic hyperplasia; bladder neck contracture; bladder outlet obstruction; holmium; holmium laser enucleation of prostate; laser therapy; lithium triborate; maximal flow rate; photoselective vaporization of the prostate; potassium titanyl phosphate; prostatic hyperplasia; quality of life score; residual urine; transrectal ultrasound; transurethral incision of prostate; transurethral resection of prostate; trial of voiding; yttrium-aluminum-garnet