Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction

被引:185
作者
Herrmann, Thomas R. W. [1 ]
Bach, T. [2 ]
Imkamp, F. [1 ]
Georgiou, A. [3 ]
Burchardt, M. [3 ]
Oelke, M. [1 ,4 ]
Gross, A. J. [2 ]
机构
[1] Hannover Med Sch, Dept Urol & Urol Oncol, D-30625 Hannover, Germany
[2] Asklepios Hosp Barmbek, Dept Urol, Hamburg, Germany
[3] Univ Clin, Dept Urol, Greifswald, Germany
[4] Univ Amsterdam, Acad Med Ctr, Dept Urol, NL-1105 AZ Amsterdam, Netherlands
关键词
Benign prostatic enlargement; Benign prostatic obstruction; Treatment; Laser prostatectomy; Thulium; Holmium; HoLEP; CONTINUOUS-WAVE LASER; 1-YEAR FOLLOW-UP; PHOTOSELECTIVE VAPORIZATION; PROSPECTIVE TRIAL; HYPERPLASIA; RESECTION; ANTIGEN; VAPORESECTION; EXPERIENCE; MORBIDITY;
D O I
10.1007/s00345-009-0503-0
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Transurethral removal of prostatic tissue is the treatment choice for benign prostatic enlargement and benign prostatic obstruction. Urodynamic results are directly linked to the amount of removed tissue which, however, is directly associated with intra- and postoperative morbidity. Transurethral laser operations of the prostate offer the advantage of decreased bleeding complications and the possibility to treat patients with bleeding disorders or anticoagulative treatment. The aim of the article is to present a novel technique of complete transurethral removal of the transition zone (enucleation) with the support of the Thulium laser to combine complete anatomical enucleation and maximum urodynamic efficacy with minimal side-effects. We present five distinct surgical steps for transurethral complete removal of the transition zone of the prostate (Thulium laser enucleation of the prostate, ThuLEP). Surgical steps are presented in chronological order with the help of intraoperative pictures. Laser energy of 70-90 W is only used for the incision at the verumontanum and bladder neck for removal of the middle lobe, whereas laser energy of 30 W was only used for coagulation of small vessel crossing the surgical capsule towards the transition zone and bladder neck for dissection of the lateral lobes. The lobes themselves are liberated by blunt dissection. ThuLEP offers complete removal of the transition zone no matter what prostatic size. The techniques combine maximum efficacy with minimal side-effects. Clinical results comparing ThuLEP with open prostatectomy or transurethral resection are awaited.
引用
收藏
页码:45 / 51
页数:7
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