HoLEP EN BLOC ENUCLEATION
Endoscopic surgery for management of benign prostate enlargement
With age, the prostate gland might present excessive benign growth. This growth can block the urethra, which travels through the gland. This, in turn, results in an increased resistance to the outward flow of urine from the bladder. If left untreated, this condition might lead to complications, such as urinary tract infections or bladder stones.
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In some cases, surgical removal of the prostate might be necessary to alleviate the blockage of the urethra. The HoLEP en block enucleation technique is a minimally invasive surgery that consists in using GreenLight laser to remove the enlarged prostate.
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The following illustrations were created to illustrate the HoLEP process for Urotec Médica S.L. and they are shared under an Attribution-NonCommercial-NoDerivatives Creative Commons licence.
The first step is to perform a circumferencial incision to mark the limit between the adenoma (the enlarged gland) and the external sphincter, which will serve as a landmark during the procedure.
Mechanical enucleation is performed with the tip of the scope to create space between the surgical capsule and the adenoma, alternating with coagulation of any capsular bleeding. Once the right side is completely liberated from the capsule, the same steps are carried out on the left side.
Once the lateral and anterior sides have been liberated, the cresta urethralis is cut at 6 o'clock and the posterior aspect is liberated. Then, the adenoma can be flipped into the bladder by lifting it and pushing it with the scope. Finally, Morcellation is carried out in the bladder.
You can learn more details about this procedure in the following article:
Common trend: move to enucleation—Is there a case for GreenLight enucleation?
Development and description of the technique
Fernando Gomez Sancha et al.