Step-by-step HoLEP with Pulse Modulated Technology

Case Record:

• Prostate vol 69 cc
• Post void volume 170 ml
• Flow rate 7 ml/sec
• AUA symptom score 23

Clinical History:

• 72 y.0.patient
• Dysuria, nycturia 2-3 times/night
• BPH, faílure of drug therapy (Tamsulosin)
• Episode of retention
• PSA 0,96 ng/ml

Other History:

Appendectomy

Technique Description:

• 1) 2 - lobe technique
• 2) Continuous flow resectoscope 26 F, passive, 12°optical lense
• 3) 120 Watt Holmium Laser with Moses technology
• 4) Enucleation: 1,2 J, 60 Hz; haemostasis: 1,2 J, 40 Hz
• 5) General anaesthesia

Procedure Steps:

• 1) Omega cut around the veromontanum
• 2) Incision at 5 o`clock towards the bladder neck
• 3) Attaching the median lobe to the right lobe
• 4) Enucleation of the left lobe with early apical release
• 5) Enucleation of the right lobe
• 6) Morcellation

Learning Points:

• 2-lobe technique
• Sphincter protection
• Early apical release
• Anatomical landmarks