Introduction & Objective : There are multiple minimally invasive procedures to treated enlarged prostates. Lasers can be used to vaporize or enucleate prostatic adenoma. Enculeation removes larger adenomas in less time, however, they require morcellation. One of the limitations of the use of Lasers in prostatectomy is lack of tissue (as in vaporization) or lost tissue architecture (as in morecellated specimens) suitable for pathological examination. By performing a hybrid vaporization/micro-enucleation technique, a faster adenoma ablation is expected & tissue can be obtained for pathological evaluation.
Methods : The video shows micro-enucleation/vaporization of the prostate using the Lumenis® Pulse-120 Laser with the Xpeeda® side-firing fiber at settigns of 2 joules, 60 Hz, short pulse width. Left side video is of a 70 years old male with bladder calculi and bladder outlet obstruction secondary to benign prostatic enlargement, the right side video is for 75 years old male who is believed to have bladder outlet procedure in the past and has recurrent voiding symptoms and what appeared as nodular re-growth of the prostatic tissue at the bladder neck and prostatic fossa on office cystoscopy, pre operative trans rectal prostatic biopsy revealed benign prostatic hyperplasia (BPH) and high grade prostatic intra epithelial neoplasia (HG-PIN).
Results : Both patients underwent the procedure as an outpatient. Micro-enucleated tissues were submitted for pathologival examination. Specimen from patient to the left revealed stromal BPH and from patient to the right revealed non invasive papillary urothelial neoplasm of low malignant potential with inverted features and benign fibromuscular tissue.
Conclusions : A combined Laser vaporization/micro-enucleation of the prostate may shorten operative time by actually removing small pieces of tissue in addition to the vaporization effect. The architecture and tissue characteristics of these pieces are preserved and good for pathological evaluation.
further exmaination required to compare oeprative times fo size matched adneomas treated by pure vaporization vs. the combined apporach.
Khaled Fareed– Assistant Professor, Cleveland Clinic, Cleveland, Ohio
Khaled Fareed, MD
Assistant Professor of Urology, Lerner College of Medicine at Case Western Reserve University and Staff Urologist at Glickman Urological & Kidney Institiue at Cleveland Clinic
Graduated from Assiut University Medical School, Egypt in 1994, completed 2 years residency training in Assiut University Hospital. finished 2 years Research fellowship at the University of Texas, Southwestern Medical Center, and Residency training in urology at the same center. joined Cleveland Clinic in 2007 and been on staff. interests in EndoUrology, Advanced laparoscopy, image-guided Therapy, Robotics and BPH, Mens voiding dysfunction.