Evidence rating: On balance, the evidence-base was rated as average. However, for some outcomes the evidence base was poor and as a result no conclusive findings could be determined for these outcomes.
Safety: The holmium laser procedures are considered at least as safe as TURP in terms of blood loss, rates of stricture and urinary tract infection. In terms of other safety indicators, such as mortality, rates of perforation, and other complications, the relative safety of the holmium laser procedures could not be determined.
Efficacy: The holmium laser procedures appear to be at least as efficacious as TURP in the short term but long-term efficacy could not be determined.
Recommendations: Additional high-quality randomised controlled trials would strengthen the evidence base for the holmium laser procedures. However, at this stage, the priority for research should probably focus on providing long-term follow-up and addressing problems with losses to follow-up which threatened the validity of many of the included studies.
Centres considering introducing the holmium laser procedures should ensure that surgeons have adequate experience in transurethral resection techniques and preferably previous experience in laparoscopic and laser surgery. An appropriate program of supervised training could best be developed by the Urological Society of Australasia.