V59 Green laser enucleation of the prostate (GreenLEP) “en-bloc technique”

INTRODUCTION AND OBJECTIVES: Laser vaporization is an alternative to transurethral resection of the prostate (TURP) for the treatment of small to medium glands. For large prostates (>80ml.) open prostatectomy or Holmium laser enucleation of the prostate (HoLEP) remains the prefered choice of treatment. Green laser ‘en bloc’ enucleation of the prostate (GreenLEP) followed by mechanical morcellation is an alternative enucleation technique developed by Fernando Gomez-Sancha in Madrid, Spain. The aim of this video is to demonstrate the GreenLEP technique step-by-step. METHODS: The surgery was performed with a 532-nm lithium triborate laser (GreenLightTM XPS 180W, American Medical Systems, Minnetonka, Minnesota, USA), 2090 side-fire laser fiber at power settings: 80W for cutting, 20W for coagulation and a PiranhaTM morcellation system (Richard Wolf GmbH, Germany) using the Vmax blade. Case Report: A 64-year-old patient presented with lower urinary tract symptoms secondary to benign prostatic obstruction with no response to alphablockers. The prostate volume was 92 mL, PSA of 2.4 ng/mL, peak urinary flow rate (Qmax) was 8 mL/sec, postvoid residual volumen (PVR) of 150 mL and international prostate symptom score (IPSS) of 22. It was decided to proceed with GreenLEP technique in this case. RESULTS: The total operative time was 64 minutes, laser time 22 minutes, morcellation time 8 minutes, total energy employed was 52kJ and 73g. of tissue were enucleated (pathology report showed no evidence of prostate cancer). The bladder catheter was removed at 24 hours postsurgery and the patient was discharged 48 hours postoperative without complication. Three months later all the parameters showed significant improvement (PSA: 0.4 ng/mL, IPSS: 4, Qmax: 26 mL/seg and PVR: 20 mL). There was no incontinence or erectile dysfunction as a result of the procedure. CONCLUSIONS: GreenLEP represents a safe alternative enucleation technique for the complete removal of en bloc adenomatous prostate tissue, regardless of gland size, it is particularly advantageous for the treatment of large prostates. Endoscopic laser enucleation of the prostate is feasible with a sidefiring fiber. Gentle mechanical dissection allows for an optimal visualization and understanding of the anatomical planes. Low energy coagulation (20W) is used against the capsule providing excellent hemostasis. These promising results warrant further studies to assess longterm outcomes.