Vapoenucleation of the Prostate

Clinical History:

• 74 years old, male.

• Prostate volume: 

• 80ml.

• Catheter due to retention 3 weeks prior to surgery.

• Urinary tract infection with Pseudomonas - treated with meropenem started 1 day prior to surgery.

• Negative prostate biopsy due to rising PSA of 9.9 ng/ml 2 months prior to laser surgery.

Other history:

• No co-morbidities, no further medications or anticoagulants.

Technique description:

• Vapoenucletion of the prostate using the GreenLight XPS™ Laser Therapy System.

• Using the anatomical approach of anatomical endoscopic enucleation of the prostate (AEEP), the GreenLight XPS™ Laser Therapy System enables surgeons to improve and enhance the durability of the established vaporization of the prostate.

Procedure steps:

1. Scoping the bladder to check for ureteral orifices.

2. Setting the laser to 180 Watts for vaporization and creating a vaporization channel using the classic PVP technique.

3. Demarking the apical adenoma and developing the enucleation plane dorsally.

4. Releasing the apical adenoma.

5. Centrally vaporizing the liberated adenoma in a stepwise manner.

6. Performing vaporesection at the bladder neck and releasing the ventral aspect of the adenoma.

7. Conducting apical ventral dissection.

8. Repeating the procedure on the contralateral lobe.

9. Performing vapoenucleation of the middle lobe.

10. Conducting final touches at the bladder neck and apical region.

11. Flushing out resectioned pieces.

12. Catheterization.

Training Objectives:

• Going beyond the classical vaporization technique of GreenLight XPS™ Laser Therapy System.

• Emphasizing anatomical landmarks and apical dissection.

• Implementing a step-by-step approach that offers "escape" routes during the learning curve.