Long‐term results of high‐power holmium laser vaporization (ablation) of the prostate

Many technological treatments for BPH have been introduced in recent years, some with successful and others with poor results. Most authors have an initial enthusiasm for their novel technique but in some cases later evaluation of long‐term results is somewhat disappointing. The holmium laser has been used in a wide variety of cases of BPH, particularly by the authors from New Zealand, who present their long‐term (7‐year) results in this section. They are happy to recommend the holmium laser on the basis of their results. Another technique for treating BPH is rotoresection. Authors from Mansoura present their short‐term results, but seem to support the previous impression that this is a potentially useful method for treating BPH. When we read about LUTS in men or women the importance of epidemiological and quality‐of‐life studies is clear, because these studies improve knowledge and act as a help in their treatment. In this section there are four such studies and it is to be expected that they will fulfil the aims stated here and be helpful to the reader. OBJECTIVE To present the 7‐year follow‐up data from the initial series of patients treated by holmium laser ablation of the prostate (HoLAP) for symptoms of benign prostatic hyperplasia at our institution. PATIENTS AND METHODS In all, 79 patients underwent HoLAP in the initial series between September 1994 and May 1995. All patients were contacted by telephone and mail; those available for follow‐up had their peak urinary flow rate, American Urological Association (AUA) symptom score, single‐question quality‐of‐life (QoL) score and adverse events assessed. Patients were also assessed using the International Continence Society ‘male short‐form’ (ICSmaleSF) questionnaire on lower urinary tract symptoms (LUTS). RESULTS At a median follow‐up of 89 months (7.4 years), 17 patients had died (21%), 28 could not be contacted or refused follow‐up (35%), leaving 34 patients (43%) available for assessment. The mean (range) AUA score of the remainder was 10.0 (0–26), the maximum urinary flow rate 16.8 (5–35) mL/s and QoL score 2.1 (0–5). The mean ICSmaleSF voiding score was 5.8 and the mean incontinence score 3.2. The impact score of their current LUTS (QoL) was 0.68, implying a minimal effect. No patient required pads for incontinence. The reoperation rate was 15%, with one patient each undergoing transurethral resection or bladder neck incision, two undergoing holmium laser enucleation of the prostate and one having a bladder stone removed endoscopically. CONCLUSIONS The long‐term results of HoLAP were satisfactory in those patients who were available for the follow‐up.