Holmium laser ablation vs. photoselective vaporization for BPH: Consider prostate size in choosing treatment

March 1, 2011

When weighing the value and efficacy of two ablation technologies used in the treatment of BPH-holmium laser ablation and photoselective vaporization-surgeons should factor the size of the prostate into their deliberations.

Key Points

Montreal-When weighing the value and efficacy of two ablation technologies used in the treatment of BPH-holmium laser ablation (HoLAP) and photoselective vaporization (PVP)-surgeons should factor the size of the prostate into their deliberations, say researchers from McGill University, Montreal.

Both technologies produce similar outcomes at 3-year follow-up.

"I would say that in small to moderately sized prostates, TURP [transurethral resection of the prostate] remains the reference standard, but holmium laser, the KTP [potassium titanyl phosphate] laser, or the newer GreenLight HPS laser can all be used. There is no rule prohibiting the use of holmium laser enucleation of the prostate [HoLEP] in the small- to moderate-size prostate," Dr. Elmansy said.

The difference between HoLAP and PVP operating times amounted to less than 15 minutes, according to data from the 2008 study. The mean operating time for 57 patients undergoing the holmium procedure was 69.8 minutes compared to 55.5 minutes for the 52 patients undergoing photovaporization. A second difference was that the prostate volume was reduced by 40.1% in the HoLAP group compared to 34.5% in the photovaporization arm. All other parameters-postoperative complication rates, International Prostate Symptom Score, maximum urinary flow rate (Qmax), quality of life, and erectile function as measured by the International Index of Erectile Function-were comparable.

Dr. Elmansy said the study that he presented at the 2010 AUA annual meeting in San Francisco was designed to ascertain the durability of the outcomes seen in the initial study and to determine whether they maintained long-term equivalency.

"The data for long-term durability is lacking. This study offers complete data out to 3 years, and we have data out to 5 years on 20% of the patients in the cohorts.