Thulium Laser Enucleation of the Prostate: Five Steps to Surgical Success

Abstract

Introduction:

Bladder outlet obstruction caused by benign prostate hyperplasia is a very common problem in urologic male patients. For large glands of >60 cc, several accepted treatment options are available: open transvesical adenomectomy, Holmium laser enucleation of the prostate, and Greenlight^™ photoselective vaporization of the prostate. ^{1 –14} In this video, we present the five crucial surgical steps of a true retrograde Thulium laser enucleation of the prostate (ThuLEP). ¹⁵

Method:

A 69-year-old man with bladder outlet obstruction (prostate volume 79 cc, International Prostate Symptom Score [IPSS] 33, prostate-specific antigen [PSA] level 5.15 ng/mL, and post-void residual 50 cc) underwent ThuLEP. The five crucial steps of the procedure are presented in the video: incision of the verumontanum, middle lobe enucleation, apical lateral lobe incision, bilateral lobe enucleation, and morcellation.

Results:

The operating time was 62 minutes; the perioperative blood loss was 0.5 g/dL. The patient was treated with a catheter for 1 day and discharged on the second postoperative day.

Conclusion:

The presented technique (ThuLEP) offers an easy and fast method of a true retrograde prostate enucleation. In contrast to open transvesical adenomectomy, Holmium laser enucleation of the prostate, and Greenlight^™ photoselective vaporization of the prostate this procedure, using the Thulium:YAG (RevoLix^®) laser offers resection, vaporization, enucleation, a sufficient histologic specimen, potent coagulation, and reduced costs due to reusable fibers and short hospitalization. After an initial learning curve, it is an easy to perform and safe procedure.

No competing financial interests exist.

Runtime of video: 7 mins