Transurethral prostateenucleation with 2 μ m laser in the treatment ofbenign prostatic hyperplasia

：Objective To investigatethe feasibility and efficacy of transurethral prostate enucleation with 2 μmlaser in the treatment of benign prostatic hyperplasia (BPH). Methods One hundred andseven patients with BPH were treated by transurethral prostate enucleation with 2 μmlaser under continuous epidural anesthesia or laryngeal mask anesthesia. The patient′s,average age was 67±9 yrs (52 to 85 yrs). Of whom, 10 patients had a history of urinaryretention. The mean prostate volume was 72.5±17.6 ml (45 to 158 ml). Two deep trencheswere cut at the 5 and 7 o, clock position from the bladder neck to the verumontanum. Theincision continued to the urethral mucosa and submucosa along with the verumontanumbilaterally in an arc-shape and ended at the internal arc of urethral sphincter. Then theurethral mucosa at the level of the verumontanum was cut and the surgical capsule planewas identified. A retrograde blunt dissection was made along the surgical capsule planewith the resectoscope sheath front-end, and the sheath was swung from side to side toextend the capsule plane. The significantly enlarged middle lobe was treated with laservaporization resection. In the same way, a trench was made at the 12 o, clock position,and the lateral lobe were removed by the sheath from the verumontanum level, finally onlytwo cord-like pedicles were kept at the 1 and 11 o, clock position at the bladder neck, sothat the removed gland tissue was fixed and hung in the gland fossa. For prostate volumeless than 60 ml, the laser vaporization resection was carried out directly. If theprostate volume was greater than 60ml, transurethral resection would be performed insteadof laser vaporization resection. With 4% mannitol irrigation, the enucleated prostatetissue was then cut into small pieces and washed out by a Braun plastic bottle through theresectoscope sheath. Intraoperative bleeding, operative time, catheterization time,postoperative voiding status, maximum urinary flow rate (Qmax) and length of hospital staywere recorded and analyzed. Results All patients successfully completed the transurethralprostate enucleation. The average operative time was 74±12 min (45-150 min). Five casesrequired blood transfusion. There was no recorded urethral stricture and no urinaryincontinence except for one patient who recovered 1 mon after the operation. The follow-uptime was 2-6 mon. The average Qmax was 6.3±0.6 ml/s before and increased to 17.5±1.5ml/s after the operation. The international prostate symptom score (IPSS) and quality oflife (QOL) were reduced from 26.4±5.5 and 4.6±0.5 to 9.3±2.1 and 2.8±0.3 after theoperation, respectively, P<0.01. Postoperative secondary bleeding was not observed.Conclusions Transurethral prostate enucleation with 2 μm laser for BPH is a safe and effective minimally invasivetreatment. Its efficacy is superior to open surgery, and even better than TURP. Key words: Benign prostatic hyperplasia;  2 micron laser;  Clinicalresearch