MP02-07 EN-BLOC GREEN LIGHT 532NM ENUCLEATION OF PROSTATE (GLEP): FIRST U.S. EXPERIENCE

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2017MP02-07 EN-BLOC GREEN LIGHT 532NM ENUCLEATION OF PROSTATE (GLEP): FIRST U.S. EXPERIENCE Kai Li, Alan Yaghoubian, Mahdi Zangi, Bo Wu, and Shahin Tabatabaei Kai LiKai Li More articles by this author , Alan YaghoubianAlan Yaghoubian More articles by this author , Mahdi ZangiMahdi Zangi More articles by this author , Bo WuBo Wu More articles by this author , and Shahin TabatabaeiShahin Tabatabaei More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.103AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The optimal management option for BPH/LUTS for prostates >80g is unclear. Theoretical advantages of GLEP include improved hemostasis due to the absorption spectrum of 532nm laser, better tissue handling due to the side-firing laser fiber, better visualization of the prostate capsule, and more versatility with concomitant vaporization. We study the safety and feasibility of en-bloc GLEP with prostate morcellation using a side-firing laser as a new technique for definitive management of symptomatic LUTS in patients with prostates >80g. METHODS We performed a retrospective analysis of 82 consecutive patients who underwent GLEP from 9/2014 to 8/2016. Primary outcomes were AUA symptom score, maximum flow rate, and post-void residual volume. Secondary outcomes were quality of life score, IIEF-5 score, and PSA. Technique: Using 26 Fr Wolf resectoscope and side-firing 2090 GreenLight laser fiber, we incise the apical mucosa, separating the prostate from the external sphincter. Using the laser energy and blunt dissection, prostate lobes are enucleated on either side of the verumontanum. Dissection is carried out circumferentially until the bladder neck is reached. Hemostasis is achieved with laser coagulation. Once the enucleated adenoma is pushed into the bladder, morcellation is completed using the Wolf Piranha morcellator. RESULTS Mean age was 71 years, with 47.6% of patients on anticoagulation and/or antiplatelet therapy. Mean procedure time was 140 min ±55. The mean preoperative prostate size was 145ml ±86.46, with a mean size morcellated volume of 66mL ± 54. 75% of patients were discharged home on postoperative day (POD) 1 and 75% of patients had catheters removed by POD2. Primary and secondary outcomes can be found in Table 1, with statistically significant improvement in all parameters (p<0.05) except IIEF-5, which demonstrated no change. Complication rates included 1.2% blood transfusion, 6.1% clot retention, 4.9% urinary tract infection, and 13.4% stress urinary incontinence. The majority of patients regained continence at later follow-up. There was no incidence of urethral stricture, capsular perforation, bladder or ureteral injury. CONCLUSIONS In experienced hands, GLEP is a safe and feasible option for management of large prostates. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e12 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kai Li More articles by this author Alan Yaghoubian More articles by this author Mahdi Zangi More articles by this author Bo Wu More articles by this author Shahin Tabatabaei More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...