Step-by-step HoLEP with Pulse Modulated Technology

Clinical History:

• 72 y.0.patient

• Dysuria, nycturia 2-3 times/night

• BPH, faílure of drug therapy (Tamsulosin)

• Episode of retention

• PSA 0,96 ng/ml

Other History:

Appendectomy

Technique Description:

• 1) 2 - lobe technique

• 2) Continuous flow resectoscope 26 F, passive, 12°optical lense

• 3) 120 Watt Holmium Laser with Moses technology

• 4) Enucleation: 1,2 J, 60 Hz; haemostasis: 1,2 J, 40 Hz

• 5) General anaesthesia

Procedure Steps:

• 1) Omega cut around the veromontanum

• 2) Incision at 5 o`clock towards the bladder neck

• 3) Attaching the median lobe to the right lobe

• 4) Enucleation of the left lobe with early apical release

• 5) Enucleation of the right lobe

• 6) Morcellation

Learning Points:

• 2-lobe technique

• Sphincter protection

• Early apical release

• Anatomical landmarks