Anatomical Enucleation of the Prostate with the Novel Combined Mechanical and Bipolar Vaporization Probe in Ejaculation Sparing and Two-Lobe Manner

Abstract

Introduction: Transurethral removal of the transitional zone gradually with transurethral resection of the prostate (TURP)/vaporization or completely with transurethral enucleation of the prostate (TUEP) is a viable surgical option for bladder outlet obstruction secondary to benign prostatic hyperplasia.1–25 TURP using high-frequency current has been considered the standard of care.8,12 The concept of TUEP, in general, and anatomical “cold” dissection has gained attention especially since the end of the 2000s. TUEP offers complete removal of prostate adenoma and can be performed with any energy source: that is, bipolar/monopolar current as well as contemporary lasers. Material and Methods: In this video, we present our technique of bipolar anatomical enucleation of the prostate in ejaculation sparing and two-lobe manner using the novel combined mechanical and bipolar vaporization probe (HERRMANN VapoEnucleation Electrode 27040VE; Karl Storz GmbH, Tuttlingen, Germany). Major surgical steps of the bipolar enucleation of the prostate (BipolEP) procedure are U-like inverted incision close to the verumontanum, mechanical exposure of the surgical capsule, detachment of the left lobe using either axial force of the splitting wedge-shaped probe or bipolar cutting, en bloc detachment of the right and median lobe, and removal of prostatic tissue by mechanical morcellation. Results: The presented technique of BipolEP is feasible and preliminary results are as expected like in other transurethral enucleation techniques. Conclusion: We display a novel technique for complete removal of the transitional zone of the prostate using a novel combined mechanical and bipolar vaporization probe (BipolEP) in ejaculation sparing and two-lobe manner. No competing financial interests exist. Runtime of video: 10 mins