Laser prostatectomy with the holmium: YAG laser.

Laser prostatectomy has generated considerable interest amongst urologists as an alternative to traditional transurethral resection for the treatment of benign prostatic hypertrophy. The majority of reports available concerning laser prostatectomy have described use of the neodymium: YAG wavelength delivered via contact or non contact fibers. Recently, a new laser wavelength has become available for urologic use. The holmium: YAG laser is a multipurpose device with many potential applications in urology as well as other surgical disciplines. At a wavelength of 2,100 nm, this laser possesses both ablative and hemostatic properties. Energy and frequency settings can be varied by the operator. Using the holmium: YAG laser as well as the neodymium: YAG laser in a combined procedure, we performed laser prostatectomies in 16 patients. In our series we used the holmium laser to vaporize a channel prior to producing quadrant irradiations with the Nd:YAG laser. At 3-month follow-up there was a mean reduction of AUA symptom scores from 19 to 9 and a mean improvement in peak flows from 13.9 to 16.6 ml/s. Early results show clinical effect but the optimal technique of combined holmium: YAG, Nd:YAG laser prostatectomy is yet to be determined.