BPH 05. Technical properties of the sliced noodles - vaporesection using the revolix 2 micron continuous wave laser for the treatment of benign prostatic hyperplasia

Objective: To analyze the technical properties of transurethral "sliced noodles-vaporesection" of prostate in the management of benign prostatic hyperplasia.

Methods: 210 patients with obstructive BPH were treated transurethrally by the "sliced noodles-vaporesection" technique using the RevoIix 70W 2 micron continuous laser with only one operator. We start the procedure with the marking of the resection border at 5 and 7 o'clock positions deep to the surgical capsule. Then performing Turner-Warwick like incisions at 5 and 7 o'clock positions to the surgical capsule joining to previous marking resection. Combined with blunt dissection and incision, we enucleate half of the median lobe.Then performing Sliced Noodles-Vaporesection crosswisely. After this step, the lateral lobes' resection was as well as the median lobes procedure. During vaporesection, it is crucial to maintain the tissue chips small enough to allow easy evacuation through the resectoscope sheath at the end of the operation.

Results: Mean operation time was 62±19 (35-140) min. 6 patients need blood transfusion during the operation, mean blood transfusion volume was 250 mL. Mean catheter time was 2.5±1.8 (1-6) d. Mean hospitalization time was 4.5±1.2 (4-7) d. all patients were follow-up time for 3 to 6 months. Mean Qmax increased from 6.8±2.5 mL/s preoperatively to 18.5±3.6 mL/ s 6 months postoperatively. IPSS and QoL-Score improved from 22.4±5.5 and 4.8±0.8 to 5.3±3.2 and 1.6±1.1 6 months postoperatively respectively (P<0.05). There were 3 cases had external urethral strictures after operation, and treated with urethral dilatation successfully.

Discussion: Through shaping the prostate tissue like a "paste" and resecting piecely, we can concentrate our attention to dissected the hole lobe from the surgical capsule. Then resecting the tissue far away from the capsure. Morever, it allow laser fiber's characteristic transverse movement to the full play in the paste resection. thus it greatly improving The efficiency. In hemostasis of the tissue, it can first resected the vessel from the root of the lobe. then greatly reduced blood supply of the paste of tissue,so keeping surgical vision clear and less prostate bleeding.

Conclusions: The method of "sliced noodles-vaporesection" of the prostate using the 2 micron laser system is a feasible, rapid, effective and safe procedure in the treatment of BPH.