Introduction & Objective : Holmium laser enucleation of the prostate (HoLEP) is a safe and effective procedure for benign prostatic hyperplasia (BPH) treatment. Incontinence following HoLEP can be encountered, although it is often temporary. To avoid incontinence, the sphincter, located in the urethra as an omega shape, must be protected. In particular, many techniques have been reported concerning enucleation step in HoLEP. With this video presentation we would like to share our experience and technique on HoLEP with respect to the external urethral sphincter and its omega shape configuration.
All HoLEP procedures were performed using a 120-W holmium: YAG (yttrium aluminum garnet) laser (Versapulse, Lumenis Inc., Santa Clara, CA, USA); a 550-nm end-firing fiber (SlimLineTM 550, Lumenis Inc.). Continuous flow 26 F resectoscope (Karl Storz, Tubingen, Germany), a rigid nephroscope with a 5-mm working channel (Karl Storz), a Versacut tissue morcellator (Lumenis Inc.) were also used. Power settings were 37.5 Watt (1.5J energy, 25 Hz frequency) in the right pedal and 100 Watt (2 J energy, 50 Hz frequency, and short-500 µs pulse width combination) in the left pedal. After the cystoscopy,the median lobe was incised from both sides from the urethral orifice line to verumontanum. This groove is deepened to the level of the surgical capsule. After both lateral lobes apex border markings, median lobe enucleation was completed. In next step, midline incisition from verumontanum to bladder neck in 12 o’clock region of the prostatic fossa. Mucosal incisitions were performed from down to up in both lobes. These incisions were connected at 12 o’clock in behind of the urethral sphincter. This image looked like an Omega Sign. Following this step, left and right prostate lobes were enuclated, respectively. This procedure was completed with morcellation.
Results : 229 patients with BPH was treated by this tecnique. All procedures were performed using the same mucosal incisions as the procedure preparation and the landmarks. No incontinance was reported.
Conclusions : We demonstrate a novel omega sign technique for preserving of the urethral sphincter during HoLEP procedure. This technique can reduce incontinence rate.
Serdar Yalcin– Urologist, Ankara, Ankara, Turkey
Eymen Gazel– Urologist, acibadem, Ankara, Ankara, Turkey
Engin Kaya– Urologist, Ankara, Ankara, Turkey
Halil Cagri Aybal– Urologist, Ankara, Ankara, Turkey
Lutfi Tunc– Urologist, Gazi University School of Medicine Dept. of Urology, Ankara, Ankara, Turkey
Ankara, Ankara, Turkey
Im working İn Acibaem University Ankara hospital as Asist.Prof in Ankara,Turkey