Korean J Urol.  2015 Nov;56(11):769-774. 10.4111/kju.2015.56.11.769.

A novel one lobe technique of thulium laser enucleation of the prostate: 'All-in-One' technique

• Kim YJ
• Lee YH
• Kwon JB
• Cho SR
• Kim JS

• KMID: 2351040
• DOI: http://doi.org/10.4111/kju.2015.56.11.769

Abstract

PURPOSE
The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here.
MATERIALS AND METHODS
From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate.
RESULTS
The mean operative time was 82.1+/-33.3 minutes. The mean enucleation time and morcellation time were 52.7+/-21.7 minutes and 8.2+/-7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9+/-24.6 g and 0.4+/-0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively.
CONCLUSIONS
The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.

Keyword

Laser therapy; Prostatic hyperplasia; Thulium

MeSH Terms

Aged
Humans
Lasers, Solid-State/adverse effects/*therapeutic use
Male
Middle Aged
Operative Time
Prostate-Specific Antigen/blood
Prostatic Hyperplasia/pathology/*surgery
Retrospective Studies
Thulium
Transurethral Resection of Prostate/adverse effects/*methods
Treatment Outcome
Prostate-Specific Antigen
Thulium

Figure

• 

  Fig. 1 Overview of 'All-in-One' technique. (A) Making an inverted-U shaped incision line. (B) Marking incision at 12 o'clock area of apex. (C) Connecting the incision line circumferentially. (D) Enucleation. Scan this QR code to see the accompanying video, or visit www.kjurology.org or https://youtu.be/ShJ6GLAR2MY.

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