Korean J Urol.  2012 Nov;53(11):779-784.

Holmium Laser Enucleation of the Prostate: Modified Morcellation Technique and Results

• Lee SH
• Choi JI
• Moon KY
• Na W
• Lee JB

Abstract

PURPOSE
We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency.
MATERIALS AND METHODS
From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique.
RESULTS
There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups.
CONCLUSIONS
In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.

Keyword

Holmium; Lasers; Prostate; Prostate hyperplasia

MeSH Terms

Holmium
Humans
Incidence
Lasers, Solid-State
Prostate
Urinary Bladder
Holmium

Figure

• 

  FIG. 1 (A) Upward technique: adenoma is aspirated superiorly after the blades are placed superior to the urinary bladder, which is followed by the morcellation. (B) Inverse technique: adenoma is aspirated inferiorly after the blades are placed inferior to the urinary bladder, which is followed by the morcellation.

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