Holmium Laser for Benign Prostatic Enlargement


Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.

Here at the Sydney Prostate Centre, we are passionate about Holmium Laser treatment for BPH (Benign Prostatic Hypertrophy).

I believe that it offers significant advantages to a standard prostate resection1.

What we do is we put a telescope in through the eye of the penis.

We have a laser fibre that is inserted through the resectoscope.

The laser then works on the prostate and it cuts and seals at the same time.

It also uses saline for irrigation, the same thing we put in a drip, so if that absorbs into the system, there’s no issue as opposed to a standard TURP (Transurethral Resection of the Prostate)2.

The Holmium Laser also cuts at the plane between the adenoma – the abnormal growing, central part of the prostate – and the capsule, so we get a wide clearance when we resect this.

This tissue is then removed piecemeal through the bladder and through the urethra, so there’s no incision.

I’ve been doing the Holmium Laser now for over fifteen years, and I’ve been extremely happy with the clinical outcomes, which is consistent with a large prospective registry-based patient cohort study in 20243.

There is less bleeding, quicker recovery, shorter catheterisation and fewer complications.3 I believe this is now the platinum standard for BPH4, and this technique will be increasingly used throughout the world and Australia.

The main stumbling block is a steep learning curve5, and the cost of the laser.

References

1. Myeong Jin Woo, Yun-Sok Ha, Jun Nyung Lee - Comparison of Surgical Outcomes Between Holmium Laser Enucleation and Transurethral Resection of the Prostate in Patients With Detrusor Underactivity - Int Neurourol J. 2017 Mar; 21(1): 46–52 - doi: 10.5213/inj.1732640.320
2. Songzhe Piao, Min Soo Choo, Myong Kim - Holmium Laser Enucleation of the Prostate is Safe for Patients Above 80 Years: A Prospective Study - Int Neurourol J 2016; 20(2): 143-150 - DOI: https://doi.org/10.5213/inj.1630478.239
3. Hyomyoung Lee, Sangwon So, Min Chul Cho - Clinical outcomes of holmium laser enucleation of the prostate: A large prospective registry-based patient cohort study under regular follow-up protocol - Investig Clin Urol. 2024 Jul;65(4):361-367. doi: 10.4111/icu.20240080
4. Edward J Bass, Ben J Challacombe - HoLEP: a platinum standard for modern benign prostatic hyperplasia treatment - 28 May 2024 https://doi.org/10.1002/tre.969
5. Jungbum Bae, Seung-June Oh, Jae-Seung Paick - The learning curve for holmium laser enucleation of the prostate: a single-center experience - Korean J Urol . 2010 Oct;51(10):688-93. doi: 10.4111/kju.2010.51.10.688.