V02-03: Transurethral Bipolar Enucleation of the Prostate (TUBE) Using the Olympus Button Electrode
Holmium laser enucleation of the prostate (HOLEP) was first described in the late 1990s as an alternative to open prostatectomy. However, the HOLEP learning curve is steep, and thus, the technique has not been widely adopted. We herein describe an enucleation technique that utilizes the Olympus &[Prime]button&[Prime] electrode that we believe flattens the learning curve significantly without sacrificing surgical outcomes.
The accompanying video illustrates a single surgeon&[prime]s technique for transurethral prostate bipolar enucleation (TUBE) using the Olympus &[Prime]button&[Prime] electrode. A retrospective review of surgical outcomes and complications from the first 48 patients that underwent the procedure by a single surgeon was performed. The technique involves a &[Prime]top down&[Prime] approach to the lateral lobes that simplifies their resection.
Mean patient age was 66.2 (+/- 8.4). Mean operative time was 95.3 (+/- 44.7) minutes. The mean weight of morcellated tissue was 23.1 (+/- 18.9) grams. Mean length of stay was 1.2 (+/- 0.97) days and average catheter time was 3.9 (+/- 3.3) days. Mean pre-operative PSA was 4.9 (+/- 3.8), post-op was 1.57 (+/- 1.31). Clavien-Dindo Grade I complications developed in 7 (15%) of patients, with 5 developing significant hematuria requiring re-catheterization and 2 patients developing post-operative UTI. The procedure was aborted in one patient when significant bladder neck undermining was recognized. New onset erectile dysfunction was noted in 2 (4%) patients. All patients reported improved voiding symptoms at a mean follow-up of 10.6 (+/- 7.2) weeks. All patients are catheter free.
We present a simplified approach to prostate enucleation that utilizes the Olympus &[Prime]button&[Prime] electrode that we believe flattens the learning curve. Further study will be required to determine the effectiveness of the technique in glands over 100 g.