Holmium:yttrium-aluminum-garnet laser prostatectomy

Abstract

As alternatives to transurethral resection of the prostate for treatment of benign prostatic hyperplasia, various types of laser prostatectomy-most notably, neodymium:yttrium-aluminum-garnet (YAG) and potassium titanyl phosphate laser procedures-have proved to be associated with considerably less morbidity (for example, bleeding, need for transfusion, intraoperative fluid absorption, and postoperative incontinence). Despite these advantages, certain disadvantages (need for prolonged postoperative catheterization and delayed symptomatic improvement) prompted investigation of the holmium:YAG laser for performance of prostatectomy. The holmium:YAG laser is highly absorbed by tissue water and causes rapid vaporization of exposed soft tissue. After initial studies in canine prostates and human prostatectomy specimens, clinical studies with the holmium:YAG laser showed no fluid absorption, appreciable blood loss, or complications, and voiding outcomes were improved immediately, similar to the result with transurethral resection of the prostate. In addition, the holmium:YAG laser has been used to perform transurethral incision of the prostate rapidly and hemostatically. Holmium laser resection of the prostate is a safe and efficacious procedure for relief of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia.