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E-TURP: TECHNICAL EVOLUTION OF TURP
V3
BPH SURGERY: A NEW BATTLEFIELD! Thursday, 27 March, 12.15-13.45, eURO Auditorium
V13
E-TURP: TECHNICAL EVOLUTION OF TURP
V14 LAPAROSCOPIC SIMPLE RETRO PUBIC PROSTATECTOMY: TECHNIQUE AND PRELIMINARY SERIES
Breda G., Celia A., Zeccolini G., Eldahashan S.
6WHPEHU'6'LVLFN*,6Hassen W.A.
San Bassiano Hospital, Dept. of Urology, Bassano del Grappa, Italy Introduction & Objectives: TURP is gold standard treatment in BPH. %LSRODUUHVHFWRUVKDYHLPSURYHGUHVHFWLRQWHFKQLTXHDQGORZHUHG7853 complications. In spite of technologic improvements, large adenomas DUH XVXDOO\ WUHDWHG E\ RSHQ RU ODSDURVFRSLF VXUJHU\ /DVHU PLJKW DOORZ HQGRVFRSLF WUHDWPHQW RI DQ\ VL]H RI SURVWDWLF DGHQRPD +R/(3 RᚎHUV minimally-invasive and radical treatment of the adenoma with the possibility of histologic exam of the enucleated tissue. This video shows a technical HYROXWLRQRIELSRODU7853WKDWLVVLPLODUWR+R/(3 Material & Methods: The video shows the main steps of e-TURP HQXFOHDWLRQ 7853 WHFKQLTXH 5HVHFWLRQ EHJLQV DFFRUGLQJ WR 1HVELW 7HFKQLTXH $IWHU EHLQJ VSOLW IURP WKH FDSVXOH DW WKH ULJKW OREH RI WKH adenoma is enucleated in a retrograde approach, starting from the apex. After reaching the surgical capsule, the adenoma is enucleated with a JRRGFOHDYDJHSODQHFRPELQLQJWKHPHFKDQLFDODFWLRQRIWKHEHDNRIWKH resectoscope with the bipolar energy. In the absence of a morcellator, the DGHQRPDPXVWQRWEHFRPSOHWHO\HQXFOHDWHGWRNHHSLWIURPIDOOLQJLQWRWKH bladder. In this case it may be “morcellated in situ” by the resectoscope loop. The same procedure is repeated for the left lobe. The operation is completed by careful hemostasis. Results: Operation lasted 70 minutes. Post operative hospital stay was 1 day. Conclusions: H7853LQRXUKDQGVLVDQHᚎHFWLYHWHFKQLTXHWRWUHDWDOVR large adenomas. It could be a more precise and cheaper endoscopic DOWHUQDWLYH WR +R/(3 5DQGRPL]HG SURVSHFWLYH VWXGLHV DUH QHHGHG WR FRQᚏUPWKLVVWDWHPHQW
0RXQW 6LQDL 0HGLFDO &HQWHU 'HSW RI 8URORJ\ 1HZ
V15 GREEN LIGHT HPS LASER PROSTATECTOMY: RECOMMENDATIONS ON SURGICAL TECHNIQUE *RPH] 6DQFKD )1, Muir G.2, Bachmann A.3, Choi B.4, Collins E.5 'H /D 5RVHWWH -6, Reich O.7, Tabatabei S.8, Woo H.9,*/8 ,QWHUQDWLRQDO*UHHQOLJKW+368VHUV*URXS 1 ,QVWLWXWR GH &LUXJ¯D 8UROµJLFD $YDQ]DGD 'HSW RI 8URORJ\ 0DGULG 6SDLQ 2King’s College +RVSLWDO'HSWRI8URORJ\/RQGRQ8QLWHG.LQJGRP 3University Hospital, Dept. of Urology, Basel, 6ZLW]HUODQG4:HLOO0HGLFDO&ROOHJHRI&RUQHOO8QLYHUVLW\'HSWRI8URORJ\1HZ
Introduction & Objectives: 3KRWR VHOHFWLYH YDSRULVDWLRQ RI WKH SURVWDWH XVLQJ WKH *UHHQ /LJKW HPS 120 W laser is a recent technological development in the use of laser as an alternative to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH). A modular approach to lasering prostate tissue is presented. Material & Methods: 6L[PRGXOHVFDQEHGHVFULEHGWKHᚏUVWRIZKLFKLQYROYHVSUHOLPLQDU\F\VWRVFRS\ GXULQJZKLFKLWLVHVVHQWLDOWRLQWURGXFHWKHF\VWRVFRSHFDUHIXOO\WRDYRLGWKHEHDNFDXVLQJXUHWKUDO or prostatic damage. The absence of any bladder tumours, congenital abnormalities at the trigone, XUHWKUDO VWULFWXUH VKRXOG EH UXOHG RXW 7KH XUHWHUDO RULᚏFHV DQG WKH EODGGHU QHFN DUH ORFDOLVHG DW WKLV WLPH 7KH QH[W PRGXOH LV WKH FUHDWLRQ RI WKH ZRUNLQJ VSDFH ZKLFK DOORZV WKH ᚏEUH WR PRYH PRUH HDVLO\ DQG SUHYHQWLQJ ᚏEUH GHJUDGDWLRQ 7KHUH DUH D QXPEHU RI DSSURDFKHV WR JHQHUDWLQJ WKHZRUNLQJFKDQQHODQGWKH\LQFOXGHDQWHULRUPLGGOH VSLUDO DQGSRVWHURODWHUDO$WWKHHQGRIWKLV PRGXOHWKHUHVKRXOGEHWZRSHUIHFWO\GHᚏQHGODQGPDUNV WKHEODGGHUQHFNDQGWKHORZHUOLPLWRI YDSRUL]DWLRQDWWKHXUHWKUDOVSKLQFWHU7KHQH[WPRGXOHLQYROYHVV\PPHWULFDOODVHULQJRIWKHODWHUDO lobes layer by layer in order to obtain a smooth surface. This is followed by lasering at the apex, which should be very precise in order to avoid damage to the sphincter. At the end of this module, all apical tissue should have been removed and the ’lonely veru’ appearance achieved. Dealing with the EODGGHUQHFNDQGPHGLDQOREHDUHLQWKHQH[WPRGXOH7KHPHGLDQOREHLVᚐDWWHQHGE\SURJUHVVLYHO\ VPRRWKHQLQJLWVFRQWRXUPDNLQJVXUHWKDWWKHEHDPLVGLUHFWHGDWWKHFHQWUHRIWKHPHGLDQOREHWKXV DYRLGLQJWKHXUHWHUDORULᚏFHV2QFHWKHPHGLDQOREHKDVEHHQᚐDWWHQHGWKHEODGGHUQHFNPLJKWVWLOO EHHOHYDWHG,QWKLVVWDJHDELODWHUDOEODGGHUQHFNLQFLVLRQ DQGRಬFORFN GRZQWRWKHFLUFXODUᚏEUHV GHOLQHDWHVWKHGHVLUHGGHSWKRIYDSRUL]DWLRQ,IWKHXUHWHUDORULᚏFHVDUHQRWYLVXDOL]HGLWPLJKWEH VDIHUWRSHUIRUPDPLGOLQHRಬFORFNLQFLVLRQᚏUVWXQWLOWKH\DUHVHHQ7KHWLVVXHEHWZHHQWKHLQFLVLRQV LVYDSRUL]HGXQWLODQXQREVWUXFWHGYLHZRIWKHWULJRQHLVDFKLHYHG)LQDOO\DWFRPSOHWLRQWKHUHVKRXOG be visible a wide open concave cavity with a smooth surface. It is important to empty the bladder WRFKHFNLIEXPSVRIREVWUXFWLQJWLVVXHSURWUXGHLQWRWKHFROODSVHGSURVWDWLFIRVVD$GLJLWDOUHFWDO H[DPLQDWLRQ FDQ DOVR KHOS WR LGHQWLI\ UHPDLQLQJ WLVVXH DW WKH SRVWHURODWHUDO DUHD 7KH ᚏQDO FDYLW\ achieved with this procedure is a wine-glass cavity rather than a channel. Conclusions: 7KH *UHHQ /LJKW +36 : ODVHU LV D VDIH DQG HᚎHFWLYH PHWKRG RI WUHDWLQJ V\PSWRPDWLF%3+$GHTXDWHWUDLQLQJVKRXOGEHJDLQHGᚏUVWLQRUGHUWRDFKLHYHRSWLPDOUHVXOWV
Eur Urol Suppl 2008;7(3):332
V16 THULIUM LASER ENUCLEATION OF THE PROSTATE Massoud W., Dumonceau O., Saheb N., Iliescu B., Schlosser J., Guetta T., Fournier F., Fennouri M., Baumert H. Paris Saint-Joseph Hospital Trust, Dept. of Urology, Paris, France Introduction & Objectives: New thulium laser generators allow transurethral enucleation of larger adenomas (>80 gr) of the prostate with DQLQVLJQLᚏFDQWPRUELGLW\7KLVYLGHRVKRZVWKLVQHZSURPLVLQJWHFKQLTXH Material & Methods: 7KH JHQHUDWRU LV D WKXOLXP ODVHU 5HYROL[ /,6$ ZRUNLQJRQDZDYHOHQJWKRIwPDQGDQRXWSXWSRZHURI:DWW:HXVH D)UODVHUVSHFLᚏF5HVHFWRVFRSHDGDSWHGIRUUHXVDEOHODVHUᚏEHU PLFURQVRIGLDPHWHU 7KHUHVHFWLRQLVUHDOL]HGXVLQJQRUPDOVDOLQHWKXV SUHYHQWLQJDQ\ULVNRI7853V\QGURPH7KHWHFKQLTXHEHJLQVE\WUDFLQJ LQGLFDWRUVOLQHVDWDQGRಬFORFNV7KHSRVWHULRUDVSHFWRIWKHDGHQRPD with an eventually median lobe are enucleated in monobloc. For each lateral lobe, the enucleation begins at the apex in a retrograde manner. The prostatic capsule must remain intact. At the end of the procedure, the two adenomas are evacuated using an endoscopic morcellator and a simple Foley catheter is inserted. Results: Mean adenoma weight preoperatively was 115 gr and mean SURFHGXUHWLPHZDVPLQ1RERG\UHTXLUHGEORRGWUDQVIXVLRQ Conclusions: Thulium laser enucleation of the prostate represents a safe DQGHᚎHFWLYHWUHDWPHQWIRUSDWLHQWVZLWKV\PSWRPDWLFHQODUJHGDGHQRPDV ! 80gr.). There is an improvement in outcome parameters and the morbidity is very low comparing to conventional open adenomectomy.
BPH SURGERY: A NEW BATTLEFIELD! Thursday, 27 March, 12.15-13.45, eURO Auditorium
V13
E-TURP: TECHNICAL EVOLUTION OF TURP
V14 LAPAROSCOPIC SIMPLE RETRO PUBIC PROSTATECTOMY: TECHNIQUE AND PRELIMINARY SERIES
Breda G., Celia A., Zeccolini G., Eldahashan S.
6WHPEHU'6'LVLFN*,6Hassen W.A.
San Bassiano Hospital, Dept. of Urology, Bassano del Grappa, Italy Introduction & Objectives: TURP is gold standard treatment in BPH. %LSRODUUHVHFWRUVKDYHLPSURYHGUHVHFWLRQWHFKQLTXHDQGORZHUHG7853 complications. In spite of technologic improvements, large adenomas DUH XVXDOO\ WUHDWHG E\ RSHQ RU ODSDURVFRSLF VXUJHU\ /DVHU PLJKW DOORZ HQGRVFRSLF WUHDWPHQW RI DQ\ VL]H RI SURVWDWLF DGHQRPD +R/(3 RᚎHUV minimally-invasive and radical treatment of the adenoma with the possibility of histologic exam of the enucleated tissue. This video shows a technical HYROXWLRQRIELSRODU7853WKDWLVVLPLODUWR+R/(3 Material & Methods: The video shows the main steps of e-TURP HQXFOHDWLRQ 7853 WHFKQLTXH 5HVHFWLRQ EHJLQV DFFRUGLQJ WR 1HVELW 7HFKQLTXH $IWHU EHLQJ VSOLW IURP WKH FDSVXOH DW WKH ULJKW OREH RI WKH adenoma is enucleated in a retrograde approach, starting from the apex. After reaching the surgical capsule, the adenoma is enucleated with a JRRGFOHDYDJHSODQHFRPELQLQJWKHPHFKDQLFDODFWLRQRIWKHEHDNRIWKH resectoscope with the bipolar energy. In the absence of a morcellator, the DGHQRPDPXVWQRWEHFRPSOHWHO\HQXFOHDWHGWRNHHSLWIURPIDOOLQJLQWRWKH bladder. In this case it may be “morcellated in situ” by the resectoscope loop. The same procedure is repeated for the left lobe. The operation is completed by careful hemostasis. Results: Operation lasted 70 minutes. Post operative hospital stay was 1 day. Conclusions: H7853LQRXUKDQGVLVDQHᚎHFWLYHWHFKQLTXHWRWUHDWDOVR large adenomas. It could be a more precise and cheaper endoscopic DOWHUQDWLYH WR +R/(3 5DQGRPL]HG SURVSHFWLYH VWXGLHV DUH QHHGHG WR FRQᚏUPWKLVVWDWHPHQW
0RXQW 6LQDL 0HGLFDO &HQWHU 'HSW RI 8URORJ\ 1HZ
V15 GREEN LIGHT HPS LASER PROSTATECTOMY: RECOMMENDATIONS ON SURGICAL TECHNIQUE *RPH] 6DQFKD )1, Muir G.2, Bachmann A.3, Choi B.4, Collins E.5 'H /D 5RVHWWH -6, Reich O.7, Tabatabei S.8, Woo H.9,*/8 ,QWHUQDWLRQDO*UHHQOLJKW+368VHUV*URXS 1 ,QVWLWXWR GH &LUXJ¯D 8UROµJLFD $YDQ]DGD 'HSW RI 8URORJ\ 0DGULG 6SDLQ 2King’s College +RVSLWDO'HSWRI8URORJ\/RQGRQ8QLWHG.LQJGRP 3University Hospital, Dept. of Urology, Basel, 6ZLW]HUODQG4:HLOO0HGLFDO&ROOHJHRI&RUQHOO8QLYHUVLW\'HSWRI8URORJ\1HZ
Introduction & Objectives: 3KRWR VHOHFWLYH YDSRULVDWLRQ RI WKH SURVWDWH XVLQJ WKH *UHHQ /LJKW HPS 120 W laser is a recent technological development in the use of laser as an alternative to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH). A modular approach to lasering prostate tissue is presented. Material & Methods: 6L[PRGXOHVFDQEHGHVFULEHGWKHᚏUVWRIZKLFKLQYROYHVSUHOLPLQDU\F\VWRVFRS\ GXULQJZKLFKLWLVHVVHQWLDOWRLQWURGXFHWKHF\VWRVFRSHFDUHIXOO\WRDYRLGWKHEHDNFDXVLQJXUHWKUDO or prostatic damage. The absence of any bladder tumours, congenital abnormalities at the trigone, XUHWKUDO VWULFWXUH VKRXOG EH UXOHG RXW 7KH XUHWHUDO RULᚏFHV DQG WKH EODGGHU QHFN DUH ORFDOLVHG DW WKLV WLPH 7KH QH[W PRGXOH LV WKH FUHDWLRQ RI WKH ZRUNLQJ VSDFH ZKLFK DOORZV WKH ᚏEUH WR PRYH PRUH HDVLO\ DQG SUHYHQWLQJ ᚏEUH GHJUDGDWLRQ 7KHUH DUH D QXPEHU RI DSSURDFKHV WR JHQHUDWLQJ WKHZRUNLQJFKDQQHODQGWKH\LQFOXGHDQWHULRUPLGGOH VSLUDO DQGSRVWHURODWHUDO$WWKHHQGRIWKLV PRGXOHWKHUHVKRXOGEHWZRSHUIHFWO\GHᚏQHGODQGPDUNV WKHEODGGHUQHFNDQGWKHORZHUOLPLWRI YDSRUL]DWLRQDWWKHXUHWKUDOVSKLQFWHU7KHQH[WPRGXOHLQYROYHVV\PPHWULFDOODVHULQJRIWKHODWHUDO lobes layer by layer in order to obtain a smooth surface. This is followed by lasering at the apex, which should be very precise in order to avoid damage to the sphincter. At the end of this module, all apical tissue should have been removed and the ’lonely veru’ appearance achieved. Dealing with the EODGGHUQHFNDQGPHGLDQOREHDUHLQWKHQH[WPRGXOH7KHPHGLDQOREHLVᚐDWWHQHGE\SURJUHVVLYHO\ VPRRWKHQLQJLWVFRQWRXUPDNLQJVXUHWKDWWKHEHDPLVGLUHFWHGDWWKHFHQWUHRIWKHPHGLDQOREHWKXV DYRLGLQJWKHXUHWHUDORULᚏFHV2QFHWKHPHGLDQOREHKDVEHHQᚐDWWHQHGWKHEODGGHUQHFNPLJKWVWLOO EHHOHYDWHG,QWKLVVWDJHDELODWHUDOEODGGHUQHFNLQFLVLRQ DQGRಬFORFN GRZQWRWKHFLUFXODUᚏEUHV GHOLQHDWHVWKHGHVLUHGGHSWKRIYDSRUL]DWLRQ,IWKHXUHWHUDORULᚏFHVDUHQRWYLVXDOL]HGLWPLJKWEH VDIHUWRSHUIRUPDPLGOLQHRಬFORFNLQFLVLRQᚏUVWXQWLOWKH\DUHVHHQ7KHWLVVXHEHWZHHQWKHLQFLVLRQV LVYDSRUL]HGXQWLODQXQREVWUXFWHGYLHZRIWKHWULJRQHLVDFKLHYHG)LQDOO\DWFRPSOHWLRQWKHUHVKRXOG be visible a wide open concave cavity with a smooth surface. It is important to empty the bladder WRFKHFNLIEXPSVRIREVWUXFWLQJWLVVXHSURWUXGHLQWRWKHFROODSVHGSURVWDWLFIRVVD$GLJLWDOUHFWDO H[DPLQDWLRQ FDQ DOVR KHOS WR LGHQWLI\ UHPDLQLQJ WLVVXH DW WKH SRVWHURODWHUDO DUHD 7KH ᚏQDO FDYLW\ achieved with this procedure is a wine-glass cavity rather than a channel. Conclusions: 7KH *UHHQ /LJKW +36 : ODVHU LV D VDIH DQG HᚎHFWLYH PHWKRG RI WUHDWLQJ V\PSWRPDWLF%3+$GHTXDWHWUDLQLQJVKRXOGEHJDLQHGᚏUVWLQRUGHUWRDFKLHYHRSWLPDOUHVXOWV
Eur Urol Suppl 2008;7(3):332
V16 THULIUM LASER ENUCLEATION OF THE PROSTATE Massoud W., Dumonceau O., Saheb N., Iliescu B., Schlosser J., Guetta T., Fournier F., Fennouri M., Baumert H. Paris Saint-Joseph Hospital Trust, Dept. of Urology, Paris, France Introduction & Objectives: New thulium laser generators allow transurethral enucleation of larger adenomas (>80 gr) of the prostate with DQLQVLJQLᚏFDQWPRUELGLW\7KLVYLGHRVKRZVWKLVQHZSURPLVLQJWHFKQLTXH Material & Methods: 7KH JHQHUDWRU LV D WKXOLXP ODVHU 5HYROL[ /,6$ ZRUNLQJRQDZDYHOHQJWKRIwPDQGDQRXWSXWSRZHURI:DWW:HXVH D)UODVHUVSHFLᚏF5HVHFWRVFRSHDGDSWHGIRUUHXVDEOHODVHUᚏEHU PLFURQVRIGLDPHWHU 7KHUHVHFWLRQLVUHDOL]HGXVLQJQRUPDOVDOLQHWKXV SUHYHQWLQJDQ\ULVNRI7853V\QGURPH7KHWHFKQLTXHEHJLQVE\WUDFLQJ LQGLFDWRUVOLQHVDWDQGRಬFORFNV7KHSRVWHULRUDVSHFWRIWKHDGHQRPD with an eventually median lobe are enucleated in monobloc. For each lateral lobe, the enucleation begins at the apex in a retrograde manner. The prostatic capsule must remain intact. At the end of the procedure, the two adenomas are evacuated using an endoscopic morcellator and a simple Foley catheter is inserted. Results: Mean adenoma weight preoperatively was 115 gr and mean SURFHGXUHWLPHZDVPLQ1RERG\UHTXLUHGEORRGWUDQVIXVLRQ Conclusions: Thulium laser enucleation of the prostate represents a safe DQGHᚎHFWLYHWUHDWPHQWIRUSDWLHQWVZLWKV\PSWRPDWLFHQODUJHGDGHQRPDV ! 80gr.). There is an improvement in outcome parameters and the morbidity is very low comparing to conventional open adenomectomy.