Thulium laser enucleation of prostate: Ejaculation sparing techniques

Abstract

Objective To report our technique for thulium laser enucleation of prostate (ThuLEP) focusing on anatomical and surgical details to pursue an ejaculation sparing intent.Patient and surgical procedure The clinical cases of two obstructed patients with an 80 ml - no median lobe - and a 45 ml - with median lobe - prostates are shown. The patients were counseled for ejaculation sparing ThuLEP. The techniques are reported step by step in the full text manuscript and the accompanying video.Results Enucleation time were 60 and 20 min, with 70.000 and 32.000 joules delivered, respectively. Catheterization time was 2 days. No complications occurred. At one-month post-operation both patients had maximum urinary flow at uroflowmetry > 20 ml/s, with virtually absent post-void residual volume. Ejaculatory function was preserved in both patients.Conclusions Based on our experience, we believe that when the ejaculatory ducts’ orifices together with the deep adenomatous tissue accommodating the ejaculatory ducts and the parallel smooth muscular fibers of the genital sphincter are spared, there is the concrete chance to pair the relief from benign prostatic obstruction and the preservation of the ejaculatory function.

Keywords

• ThuLEP
• BPH
• BPO
• LUTS
• Ejaculation