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Holmium laser treatment of prostate gland

Holmium Laser Enucleation of Prostate

It has been over two decades that various forms of laser generators have been used to ablate the obstructing prostatic adenoma. However in last 5 years two such modalities have gained stability while others have largely failed to survive.  Holmium Laser enucleation of Prostate (HOLEP)  involves high power (100 watts) laser energy generated using Holmium Yag medium to be delivered through an end firing contact probe. By moving this probe all around the adenoma it can be enucleated and dropped into the urinary bladder, where it could be morcellated and sucked out piecemeal. The probe works like the finger of a surgeon performing open prostatectomy.

Advantages:

  1. Almost blood less surgery, minimal blood loss
  2. Excellent vision through the telescope as there is no bleeding
  3. Normal saline may be used as irrigant
  4. Short catheter period; 24-36 hours
  5. Quick recovery
  6. Early return to work
  7. Very low incidence of stricture urethra and reactionary haemorrhage
  8. Advisable in patients with coagulation disorder
  9. One of the best options for prostate glands more than 100 gms

  Disadvantages:
  1. High cost of equipment
  2. Recurring cost of fibre
  3. Steep learning curve

Holmium Laser Enucleation of prostate ( HoLEP) in BPH more than 200gms

As presented in the Annual conference of North Zone Urological Society of India (2009)


Introduction : Innovations in technology have resulted in better treatment outcomes. One such technological advancement is development of high power Holmium Laser which has been successfully utilized in the treatment of Benign Hyperplasia of Prostate (BPH). Unlike Photo selective vaporization, size of the prostate gland does not preclude the use of Holmium laser for surgical treatment of BPH.

Aim : To present the results of six cases of BPH more than 200gms treated withHolmium Laser Enucleation of Prostate (HoLEP).

Material and Methods : Between Oct 2005 and June 2009, a total of 325 such patients underwent HOLEP using 100 watts Holmium laser generator at our hospital. Out of these, six patients had prostate gland estimated to be more than 200 grams. Symptoms of Bladder outlet obstruction due to enlarged prostate gland were evaluated for need of surgical intervention. A record of their IPSS score, medical co morbidities, size of prostate, volume of residual urine, and urinary flow rates was made. An end firing reusable laser fibre of 550 micron size was used to enucleate the prostate gland .The enucleated adenoma was removed using a morcellator. An immediate post operative hematocrit value was obtained and compared with the pre operative value. Indwelling catheter was kept for 72hrs except in the first case in which it was kept for 96 hours.


Results and Conclusions : All patients had uneventful recovery. Blood transfusion was required in the first 2 cases only. Transient stress incontinence occurred in the first two cases, and urinary tract infection occurred in two cases. Significant improvement in the IPSS score was documented in all cases. The clinical outcome was comparable to other series reported in the literature. HoLEP is a safe and effective modality of treatment for obstructive BPH in large sized prostate glands.

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