Rijo Enrique, Misrai Vincent, Gomez-Sancha Fernando
Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain.
Department of Urology, Clinique Pasteur, Toulouse, France.
Urology. 2019 Feb;124:308. doi: 10.1016/j.urology.2018.10.031. Epub 2018 Oct 26.
The vapoenucleation of the prostate using green laser is an alternative hybrid technique between vaporization and enucleation. It consists of vaporizing the lateral lobes and enucleating the median lobe. The advantages compared with photoselective vaporization of the prostate (PVP) are: a fairly fast operation, low reoperation rates, it is suitable for large glands and provides pathology specimen. The aim of this video is to demonstrate the vapoenucleation technique step-by-step.
The surgery was performed with a 532-nm lithium triborate laser (GreenLight XPS 180W, American Medical Systems, Minnetonka, Minnesota), MoXy side-fire laser fiber at power settings: 180 W for cutting, 35 W for coagulation and a Piranha morcellation system (Richard Wolf GmbH, Germany).
A 68-year-old patient presented with lower urinary tract symptoms secondary to benign prostatic obstruction. The prostate volume was 88 mL, PSA of 3.4 ng/mL, the peak urinary flow rate (Q) was 7 mL/s, the postvoid residual volumen was 160 mL and international prostate symptom score was 22.
The total operative time was 72 minutes, total energy employed was 354 kJ and the pathology report showed no evidence of prostate cancer (35 g). The bladder catheter was removed at 24 hours postsurgery and the patient was discharged 48 hours postoperative without complications. Three months later all the parameters showed significant improvement (PSA: 1.02 ng/mL, international prostate symptom score: 4, Q: 43 mL/seg and postvoid residual volumen: 15 mL).
Green laser vapoenucleation of the prostate represents a safe alternative technique for the complete removal of adenomatous prostate tissue, regardless of gland size, and it is particularly advantageous for the treatment of large prostates. This technique can also be used as an intermediate step during the learning curve of "en bloc" green laser enucleation of the prostate (GreenLEP). These promising results warrant further studies to assess long-term outcomes.
使用绿色激光对前列腺进行汽化去核是汽化和去核之间的一种替代性混合技术。它包括汽化侧叶并切除中叶。与前列腺光选择性汽化术（PVP）相比，其优点是：手术相当快，再次手术率低，适用于大腺体并能提供病理标本。本视频的目的是逐步演示汽化去核技术。
手术使用532纳米硼酸锂激光（GreenLight XPS 180W，美国美敦力公司，明尼苏达州明尼通卡）、功率设置为切割180W、凝固35W的MoXy侧射激光光纤以及Piranha组织粉碎系统（德国理查德·沃尔夫有限公司）。
一名68岁患者因良性前列腺梗阻出现下尿路症状。前列腺体积为88毫升，前列腺特异性抗原（PSA）为3.4纳克/毫升，最大尿流率（Q）为7毫升/秒，残余尿量为160毫升，国际前列腺症状评分22分。
总手术时间为72分钟，总能量使用为354千焦，病理报告显示无前列腺癌证据（35克）。术后24小时拔除膀胱导管，患者术后48小时出院，无并发症。三个月后，所有参数均有显著改善（PSA：1.02纳克/毫升，国际前列腺症状评分：4分，Q：43毫升/秒，残余尿量：15毫升）。
绿色激光前列腺汽化去核术是一种安全的替代技术，可完全切除腺瘤性前列腺组织，无论腺体大小如何，对大前列腺的治疗尤其有利。该技术还可作为前列腺“整块”绿色激光去核术（GreenLEP）学习曲线中的一个中间步骤。这些有前景的结果值得进一步研究以评估长期疗效。
