A Personal Reflection of Greenlight 532 nm Laser for BPH Treatment
Figure 1
Transurethral laser enucleation/vaporization technique. (a) A wide incision is made through the median lobe until the bladder neck fibers can be seen. This channel should be wide enough to ensure a strong flow of cooling irrigant. Then, incisions are made lateral to the median lobe. It is important to visualize the ureteric orifices. (b) The intervening tissue between the incisions, if large, is divided into smaller chips. The chips are vaporized to reduce bulk before they are incised and placed into the bladder. (c) The median lobe is removed in this manner on both sides to view the ureteral orifices well from behind the bladder neck. (d) Multiple vaporization enucleation incisions are made starting at the 11 o’clock position of the lateral lobe down to the fibers of the prostatic capsule. The 11 o’clock incision is continued medially to join the median lobe defect at the 7 o’clock position. Intervening tissue is vaporized, incised, and pushed into the bladder. The same procedure is done to the other side to remove the contralateral lateral lobe starting at the 1 o’clock position to the 5 o’clock position. Apical tissue proximal to the verumontanum is carefully ablated with care to preserve the verumontum. (e) Anterior tissue at the 12 o’clock position is then incised, vaporized, and enucleated as needed to connect the 1 o’clock to the 11 o’clock position. The goal is to achieve a TURP like cavity with removal of tissue to capsule and with view of the ureteral orifice as well as removal of any intravesical components. After resection is completed, the tissue chips are irrigated out with combination of transurethral evacuators and graspers. With careful lasering of tissue to small chips, use of a morcellator is unnecessary.
