A new application system for the holmium laser resection of the prostate

摘要

The clinical outcome of the holmium laser resection of the prostate (HoLRP) shows similiar results when compared to the transurethral resection of the prostate (TURP). Our efforts had been to solve certain problems in the clinical application, e.g. the angle fiber/tissue in the apex area of the prostate and the movements of the shaft during the resection. The authors present a new application system for the laser resection and review their own experience in the development and clinical application of Holmium:YAG laser technology for prostatectomy. Between 3/97 and 12/98, 79 patients were treated with the holmium laser resection of the prostate. The laser resections with the specially designed laser-resectoscope were performed from 5/98-12/98 (n = 28 patients). With the new resectoscope a proper instrumentation became available. A ceramic tip mounted lever provided a deflection at an angle of 20°of the fiber without any damage of the applicator during the laser application. The manipulation of the fiber within the shaft in all three directions makes an enucleation of the prostate possible. The mean operating time was 63 minutes. There were no acute perioperative complications. The mean postoperative AUA symptom score was 9.1 compared to 22.5 preoperatively. The mean postoperative peak flow rate was 19.1 ml/s compared to 7 ml/s preoperatively. The new technical device improves holmium laser prostate resection and a combination of techniques (e.g. the morcellator) provides an effective method with minimal complications and morbidity.