title: Holmium Laser vs Monopolar Electrocautery Bladder Neck Incision for Prostates Less Than 30 Grams: A Prospective Randomized Trial.
abstract: OBJECTIVE
  To compare the efficacy and results of bladder neck incision (BNI) in bladder outlet obstruction (BOO) in men with a small prostate using holmium laser vs conventional monopolar electrocautery technique.
  
  
  METHODS
  This study included 140 patients of BOO (prostate size ≤ 30 cc, American Urological Association (AUA) score ≥ 8, Qmax ≤ 15 mL/sec, and Schäfer grade ≥ 2) who were randomly assigned to holmium laser BNI (HoBNI) or conventional BNI (C-BNI). AUA score and Qmax were assessed preoperatively and postoperatively at 3, 6, and 12 months. At 6 months, detrusor pressure at Qmax, Schäfer grade, and postvoid residual were assessed.
  
  
  RESULTS
  The incidence of postoperative hematuria and blood transfusion in the C-BNI group were 4.2% and 2.8%, respectively. No patient in the HoBNI group developed hematuria or required blood transfusion. Qmax and AUA score at each follow-up, and Pdet Qmax, Schäfer grade, and postvoid residual at 6 months were comparable between two groups but showed significant improvement when compared to baseline in both the groups. At 6 months, 2.9% patients in the HoBNI group and 4.3% in the C-BNI group remained obstructed urodynamically and underwent reoperation (P > .05). The incidence of retrograde ejaculation was significantly higher in HoBNI (22.9% vs 6.1%, P -.02) CONCLUSION: Both procedures are equally efficient in relieving BOO in patients with prostate size < 30 cc and have similar success rates. The risk of postoperative hematuria is less with HoBNI because of its better hemostatic properties, but its use must be counterbalanced with significant increase in incidence of retrograde ejaculation.
authors.affiliation: King George Medical University, Lucknow, Uttar Pradesh, India. Electronic address: ankurbansaldmc@gmail.com.
authors.forename: Ankur
authors.initials: A
authors.lastname: Bansal
authors.affiliation: King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Satyanarayan
authors.initials: S
authors.lastname: Sankhwar
authors.affiliation: King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
authors.affiliation: King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Jhanwar
authors.affiliation: King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Bimalesh
authors.initials: B
authors.lastname: Purkait
authors.affiliation: King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ruchir
authors.initials: R
authors.lastname: Aeron
authors.affiliation: King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Sunny
authors.initials: S
authors.lastname: Goel
mesh_terms: D004564:Electrocoagulation; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059411:Lower Urinary Tract Symptoms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D001743:Urinary Bladder / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods