Transurethral Enucleation of the Prostate with Plasma

Technique Description:

• 1) Continuous flow resectoscope 27 F, active, 12°
• 2) HF-Generator, bipolar 200 W cutting, 120 W coag.
• 3) Pre-warmed NaCl solution (32°C)
• 4) Spinal anesthesia

Procedure Steps:

• 1) Resection of 6 o’clock channel
• 2) Enucleation of the left lobe
• 3) Resection of the enucleated lobe
• 4) Enucleation and resection of the right lobe
• 5) Trimming of the bladder neck
• 6) Coagulation, chip removal, catheter

Learning Points:

• Transurethral mechanical enucleation technique
• Avoidance of morcellation
• Anatomical landmarks
• Prograde ejaculation preserving technique

Clinic History:

• 68 y.o. patient
• Severe dysuria, nycturia 3-4 times/night
• PSA 2.51
• BPH, failure of drug therapy (Tamsulosin)
• Vol. 60cc, multiple calcifications esp. left lobe
• Res. Vol. 30ml

Other History:

• Comorbidity
• Nephrolithiasis