Anatomical en-bloc HoLEP using MOSES 2.0 laser

Clinical History:

• A 75 year-old male patient.
• TRUS prostate volume: 95cc.
• PSA: 3 ng/mL
• Qmax: 8 mL/sec
• IPSS: 26
• The patient has a permanent catheter due to a urinary retention 3 months ago.

Other History:

• History of anticoagulant treatment.
• He is on dual medical treatment with alpha blockers and finasteride.
• The patient stopped taking his oral anticoagulant treatment 5 days before the procedure and now is taking enoxaparin.

Technique description:

• Anatomical en-bloc Holmium laser enucleation of the prostate using the Lumenis MOSES 2.0 laser and the Piranha morcellator (Richard Wolf GmbH).

Procedure steps:

1. Identify anatomical landmarks.
2.  Apical dissection.
3.  En-bloc enucleation (dissection of the lateral lobes, anterior and posterior dissection).
4.  After the enucleation, the enucleated tissue is removed through a process of mechanical morcellation.

Trainings Objectives:

• To learn the ‘en bloc’ (one piece) holmium laser enucleation of the prostate (HoLEP).