MP42-06 THE EN BLOC HOLEP TECHNIQUE: OUR EXPERIENCE

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2016MP42-06 THE EN BLOC HOLEP TECHNIQUE: OUR EXPERIENCE Alim Dymov, Nikolay Sorokin, and Andrey Vinarov Alim DymovAlim Dymov More articles by this author , Nikolay SorokinNikolay Sorokin More articles by this author , and Andrey VinarovAndrey Vinarov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.194AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Holmium laser enucleation of the prostate (HoLEP) has become an increasingly popular treatment for symptomatic benign prostatic hyperplasia (BPH) that allows complete removal of the tissue in the transition zone regardless of the prostate size. Despite the advantages of HoLEP, considerable training and a steep learning curve are required to master this surgical technique for safe operation. Usually, the traditional three-lobe technique described by Gilling is used for HoLEP. However, it is known that there are some difficulties in enucleating the median lobe. Sometimes a surgeon can even cause the prostate capsule perforation into the retrovesical space near the bladder neck, since the capsule is anatomically very thin and the exfoliation angle might be very sharp at that lesion. Recently, a new, ‘en bloc’ enucleation technique was introduced which enhances safety and shortens operative time. ? METHODS About 300 patients underwent HoLEP in our institution since 2013. 34 of them underwent HoLEP with the en bloc enucleation technique, with lateral median approach to the median lobe. The procedure included the following maneuvers: (1) Early encircling mucosal incision at apical adenoma, (2) Lateral to median exfoliation of median lobe at bladder neck, (3) Lateral approach to bladder neck at upper portion, (4) Retrograde exfoliation of hang down adenoma at 12 o’clock position, and (5) En bloc downward morcellation of the enucleated adenoma. A Lumenis VersaPulse® PowersuiteTM 100W was used in all cases with 1.4J/50 Hz settings. Total operating time, enucleation and morcellation time, adenoma weight, and complications were recorded.? RESULTS Prostate adenomas removed were divided into medium (40-79 grams, n=18) and large adenomas (=80 grams, n=16). For medium-sized adenomas (59 g ± 10.3), mean total operating time was 66 minutes ± 18, mean enucleation time was 36.3 min ± 12.1, and mean morcellation time was 10.7 min ± 4.4. For large adenomas (106.5 g ± 19.5), mean total operating time was 90.3 minutes ± 31.4, mean enucleation time was 47.1 min ± 20.3, and mean morcellation time was 21.7 min ± 12.6. No major intra- and postoperative complications were observed. Postoperative data showed that HoLEP is highly effective in the treatment of bladder outlet obstruction. A lower percentage of capsule perforations and fewer cases of stress urinary incontinence were observed in the en bloc HoLEP group compared with the traditional HoLEP group. ? CONCLUSIONS The use of the ‘en bloc’ technique may improve operative times, decrease complications rates, and even shorten the learning curve for urologists mastering the HoLEP procedure. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e571 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alim Dymov More articles by this author Nikolay Sorokin More articles by this author Andrey Vinarov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...