TRANSURETHRAL ENUCLEATION OF PROSTATE WITH OLYMPUS ESG 400 SISTEM USING BUTTON ELECTRODE (TUEP-B) FOR THE TREATMENT OF CLINICAL OBSTRUCTING BENIGN PROSTATE HYPERPLASIA: NUOVA VILLA CLAUDIA’S EXPERIENCE

VIDEO 2012

Roberto Giulianelli, Luca Albanesi, Francesco Attisani, Barbara Cristina Gentile, Davide Granata, Luca Mavilla, Gabriella Mirabile, Francesco Pisanti, Manlio Schettini, Giorgio Vincenti

Division of Urology – Nuova Villa Claudia- Rome-Italy

INTRODUCTION

Conventional transurethral resection of the prostate (TURP) still remains the gold standard treatment of LUTS due to bladder outlet obstruction (BOO) for benign prostatic hyperplasia (BPH). Since 2003 in our department, using OLYMPUS BIPOLAR SISTEM, we performed over 3000 bipolar prostate resection. From December 2011 we started to use PLASMAKINETIC BUTTON TURis ESG 400 SYSTEM to perform endoscopic prostate vaporization. The video shows theTransurethral Enucleation of prostate technique using button electrode (TUEP-B) with the support of Gyrus PK system.

MATERIALS AND METHODS

A 74 years old man, suffering fromnon-insulin dependent diabetesmellitus (DMNID)indrug treatmentand hypertensionwith a gooddynamiccompensation, presenteda clinical conditionof severecervico-urethral obstructionnon-responders to medicationtaken(Dutasteride 0,5mg/ dayplussilodosin8mg/ day). We performed an ultrasound examination of the whole urinary tract, including TRUS, which excluded the presence of cancer and urinary lithiasis but showed signs of cervico-urethral obstruction (bladder wall thickening, PVR > 100 ml) and an increased prostate volume (about 45 gr). Urodynamic evaluation confirmed the diagnosis of severe cervico-urethral obstruction. PSA value was normal.

We performed a Transurethral Enucleation of Prostate with Button electrode (TUEP-B) following by the resectionof “peduncolated adenomawith aESG 400 system loop, usinga continuous-flowresectoscope with optical 12 degree. Surgical time was about 20 minutes. Histological examination showed fibroadenomyomatosa hyperplasia of the prostate with some areas of chronic inflammation.

RESULTS

Aninitialurethroscopywith 12degrees optic was performed andfollowed by acystoscopyto exclude the presenceofconcomitant illnesses.The surgical technique ofenucleationconsists ininitiallyidentifingthe edgeofadenomatoustissueatverumontanum. At this level, an anticlockwise direction incision was made, from 5 to 1, and then proceed withbuttonlooptocreate an appropriatecleavage planebetween theleft lobe of adenoma andthe capsule,up to the bladder neck, so to determine,in a retrogradeway a progressive “tissue peduncoletion”.This permitsto quickly find outanavascular plane.The procedurewascarried out also forthe right lobe, starting from an apical incision from 7 to 11.The roofof the adenoma is treated from the bladder neck to the apex with the same method.

The procedure was completedusingOlympusESG 400 loop to obtain acomplete resectionof the tissue,thus avoidingto proceed with themorcellationof the adenomain the bladder. The procedure ends with a careful control of hemostasis and placement of a 20 Ch catheter. The optimized spherical shape button in combination with the easy to learn “honering technique” results in an effective, fast ablating and virtually bloodness vaporization of the tissue. The plasma corona creates well coagulated tissue and a smooth surface. Postoperative course was uneventful and hemoglobin level essentially unchanged. After 24 hours the 20 Ch catheter was removed and the patient subsequently dismissed. After three months we made uroflowmetry showing a standard maximum flow rate, no PVR and IPSS was < 7.

CONCLUSIONS

Transurethral Enucleation of Prostate with Button electrode (TUEP-B) is a potential new alternative to standard TURP and allows virtually bloodness resections, good tissue removal and a prostatic TURP-like cavity.