New England Section of the American Urological Association

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En Bloc Enucleation of the Prostate
Robin Djang, MD, Michael T. Grant, MD
Dartmouth Hitchcock Medical Center, Lebanon, NH

Background:
Lower urinary tract symptoms (LUTS) are a common constellation of symptoms classically associated with bladder outlet obstruction from prostatic hyperplasia. Several medical and surgical options exist for management of bladder outlet obstruction secondary to prostatic hyperplasia. In this surgical video, we discuss the indications, techniques, and step-by-step procedure to perform a Greenlight photovaporization and enucleation of the prostate (PVEP).
Methods:
A 72-year-old male was admitted for an episode of acute urinary retention complicated by urosepsis. He was referred to urology for follow up evaluation with a catheter in place. Prior to his episode with urinary retention, the patient reported an IPSS 27 with QoL 5. He had a 132cc prostate as confirmed on TRUS.
Results:
The accompanying video illustrates the following principles: proximal and distal limits of dissection, the technique for adenoma dissection and enucleation, morcellation of the specimen, and use of the Greenlight laser system. On a 1 month follow-up visit, the patient reported IPSS 2, QoL 0, with a PVR 13cc. No readmissions or ED visits. No incontinence and no change in erectile function.
Conclusion:
The accompanying video illustrates the principles for evaluation and surgical management of prostatic hyperplasia and bladder outlet obstruction using the Greenlight laser system to perform a photovaporization and enucleation of the prostate in safe, controlled manner.


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