Holmium laser assisted ′anatomical′ enucleation of adenoma of benign hyperplasia of prostate

Abstract

<b>Aims: </b> To present our technique of Holmium Laser assisted ANATOMICAL enucleation of the benign prostatic adenoma (HoLEP) in 219 patients. Procedure is based on the principle of digital enucleation of the adenoma from its surgical capsule, but performed entirely by perurethral endoscopic technique assisted by Holmium Laser. <b> Materials and Methods: </b>From March 2001 to November 2004, 219 patients under went HoLEP. After the initial cuts from bladder neck to verumontanum at 5 and 7 o'clock position, capsule is identified. The beak of the resectoscope sheath was inserted in the plane between the capsule and the adenoma and the adenoma was physically pushed away towards the urethra from the capsule. Laser was used to coagulate the bleeders, to cut the mucosal attachments and tough stromal tissue. Procedure was repeated for median and two lateral lobes. There was minimal bleeding and fluid absorption. Complications were few. <b> Results:</b> In 206 cases successful enucleation of the adenoma was carried out. First 13 cases formed part of the learning curve and were completed by standard transurethral resection of prostate (TURP). IPSS score dropped from average of 23 to 8 and peak flow improved from<11 to >20. No patient had postoperative urinary incontinence or stricture. <b> Conclusions:</b> HoLEP is an effective alternative to TURP. Ultimate end results replicate the end results of open enucleation of BPH without its morbidity and have all the advantages of endoscopic surgery. It offers distinct advantages over standard TURP as the incidence of blood transfusion and fluid absorption are greatly minimized.