Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

Lower urinary tract symptom caused by benign prosthetic hypoplasia is a common condition in older males. Our new technology, 980 diode laser enucleation, can be used to treat this condition. Diode lasers can simultaneously absorb both water and hemoglobin.

Compared to other procedures, diode has fewer intra-operative complications, a shorter learning curve, and achieves a greater t-cell reception. Before beginning the procedure, confirm the availability of 980-nanometer diode laser with an 80 to 100-watt continuous power source. 30 minutes before the procedure, administer an intravenous antibiotic to the patient and have the patient lie on the operating table.

When the patient is in position, use the resectoscope to observe the urethra, verumontanum, bladder neck, urethral orifices, bladder mucosa, and trabecular hyperplasia. Use the laser to make a three to four-millimeter wide circular incision in the bladder neck mucosa, and a three to four-millimeter circular incision in the proximal end of the verumontanum of the prostatic urethra mucosa. Then connect the concentric circles of the bladder neck and the apex of the prostate in the posterior urethra at 12 o'clock, and incise the left and right lobes of the bladder.

Then to create the channel, locate the surgical capsule at the five and seven o'clock positions of the apex of the prostate, and the surgical capsule at the five and seven o'clock surgical capsule positions. Then connect the five and seven o'clock surgical capsule positions with the laser. At the six o'clock position of the prostate's apex, separate the median lobe from the surgical capsule from the prostate's apex to the bladder neck.

For lobe enucleation, use the resectoscope to enucleate the right lobe at 6 and 12 o'clock from the apex of the prostate to the bladder neck in a counterclockwise direction. Enucleate the left lobe at 6 and 12 o'clock from the apex of the prostate to the bladder neck in a clockwise direction. Then push all of the glands into the bladder.

To stop bleeding around the site, place a 50-watt laser one to three millimeters from the sites of bleeding to achieve hemostasis within the surgical area. To morcellate the enucleated prostatic tissue, use a morcellator to break the tissue into as small pieces as possible, and remove the tissue from the bladder. When all of the enucleated tissue has been removed, remove the morcellator from the urethra and gently insert a 22-French Foley catheter lubricated with lidocaine gel through the urethral orifice into the bladder cavity.

Then inflate the balloon with 30 milliliters of water. In this clinical study, all 40 of the patients with benign prostatic hypoplasia who underwent diode laser enucleation successfully completed the operation, and almost all of the patients had the catheter removed within five days of the procedure. All of the patients returned to the hospital for follow-up examinations in the first, third, and 12th months postoperatively.

The International Prostate Symptom Score and quality of life tools were used to screen for, rapidly diagnose, track the symptoms off, and suggest the management of the symptoms of benign prostatic hyperplasia. Compared to baseline values, the International Prostate Symptom Score and quality of life both significantly decreased at one, three, and 12 months postoperatively. The mean Qmax increased nearly threefold, and the mean post-void residual decreased nearly fourfold.

Compared to the preoperative values, the prostate volume also decreased dramatically. According to the modified Clavien-Dindo Classification system, no patient had complications intraoperatively, and only four cases reported grade one postoperative complications. It's critical that the channel is created in the correct location and the manner to reduce the chance of injury to the sphincter and neck of bladder.

Also, other lasers may be used. Their performance will not be as accurate as that achieved using diode light. Diode light provides a new tool for the treatment of the benign prosthetic hyperplasia and encourages the urologists to consider the physical characteristics of different lasers to improve the outcome of the procedure.