Are Lasers Safe to Treat Large Prostates?


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The average size of the prostate in healthy men is 20 to 25 grams, but among men who develop an enlarged prostate (benign prostatic hyperplasia, BPH), it typically grows two to four times that size. In some men, however, the prostate gland reaches more than 200 grams. In such cases, special techniques may be necessary, which raises the question, are lasers safe to treat BPH and large prostates?

A new study reports that use of holmium-laser enucleation of the prostate (HoLEP) along with mechanical morcellation is an effective and safe approach for men who have an extra large prostate.

HoLEP is an outpatient procedure that utilizes laser to remove the prostate tissue that is blocking urinary flow and to prevent the tissue from regrowing. While complications such as urinary incontinence and bleeding are uncommon after HoLEP, about 10 to 15 percent of men who have prostates larger than 100 grams may experience stress incontinence.

In a new study from Alberta, Canada, researchers report on 58 men whose prostates weighed at least 200 grams (average, 218 grams) and who underwent HoLEP combined with mechanical morcellation. Mechanical morcellation is the process of dividing tissue such as a tumor into small pieces.

The surgeons removed an average of 213.4 grams of tissue. Overall, the average American Urological Association Symptom Score declined from 18.9 before HoLEP to 3.85 one year after the procedure. The complication rate was 3.4 percent.

The researchers concluded that the combination of HoLEP enucleation (removal of prostate tissue) and morcellation is among the best surgical treatments for men with BPH. Results of the study were presented at the Canadian Urological Association’s 2012 annual meeting.