8° Congresso Nazionale UrOP, Ravello; Maggio 2013.

THULIUM LASER ENUCLEATION OF THE PROSTATE IN A PULSED MODALITY

L. Carmignani, C. Marenghi, P. Stefano, S. Casellato, G. Bozzini (San Donato Milanese)

Aim of the study

We present Thulium Laser Enucleation of the Prostate in a pulsed modality. P-Thulep is an
innovative way to use Thulium laser in the field of EndoUrology.

Materials and methods

The patient of this surgical procedure has a 66 ml prostate and was catheterized before. He had a
prostatic biopsy for an elevated PSA with histopathological evidence of BPH. After a preliminar
cystoscopy, landmarks like ureteral orifices and veru montanum are highlighted. A 5 and 7 o’clock
incisions of the bladder neck till the prostatic capsule is performed. Found the right plane at the
level of the veru montanum the retropulsion and the enucleation of the third lobe starts. Left lateral
lobe enucleation starts with a lateral incision proximal to the sphincter, from veru montanum to 12
o’clock. The correct plane on the bladder neck has to be reached at 12 o’clock too, with a junction
between the two incisions. As done for the median lobe, an enucleation thanks to a weak
retropulsion is performed. A specular procedure is done for the right prostatic lobe. At the end of
the enucleation procedure an accurate haemostatis is carried out. The last step of the procedure is
the morcellation of the prostatic lobes. TRUS imaging can give the idea of a wide bladder neck with
an empty prostatic loggia.

Results
7 days after procedure Flowmetry shows a normal urinary flow.

Discussion
Thulium laser has a minimal tissue interaction mainly due to a low water penetration of just 0.1 –
0.2 mm. Compared to the green laser, Thulium laser allows a good ablation, vaporization and
coagulation in any phase of the procedure. This is possible because water (always present inside the
tissues) is the cromophore so different from haemoglobin or oxyhaemoglobin. A different emission
modality is the main aspect between Holmium laser and Thulium one. Holmium laser can only
work on a pulsed modality, while Thulium laser can be used in a continuous or pulsed modality,
thanks to an accurate impulse timing control.

Conclusions
Thulium laser pulsed modality enhances cut purpose, treated tissues remains white. Continuous
emission (usually used for vaporization and vapo-resection) has mainly a coagulative and
vaporization aim.