Abstract
Introduction:
Holmium Laser enucleation of the prostate (HoLEP) is an effective treatment, yet the learning curve is considered difficult. We propose the trimodal approach of Holmium Laser ablation (HoLAP), then ablation with resection (HoLARP) and finally enucleation (HoLEP) during the development of surgical competence.
Methods:
A centre experienced in Holmium Laser (HoL) prostatectomy evaluated ablation techniques in prostates less than 50cc as a training modality. Prospective data were collected and outcomes compared with controls who had HoLEP. Subsequently a HoL prostatectomy service was introduced to a new centre and evaluated prospectively during the initial experience of two surgeons mentored by another trained in the trimodal staged approach.
Results:
Outcomes following HoLAP were comparable to HoLEP in prostate volumes under 50 cm3. The new HoL service was evaluated over 6 months. 70 cases were carried out, 42 HoLAP and 28 HoLEP. Outcomes were compared prospectively with 30 TURPs by another surgeon. A decrease in catheterisation time and hospital stay was noted in the laser group.
Conclusion:
The staged progression from HoLAP, then HOLARP and finally to HOLEP with morcellation appears a safe and reproducible way to introduce HoL prostatectomy into standard urological practice.
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