Slimline

We used an 80–120-W holmium laser (VersaPulse Select, Lumenis Pulse 120H with Moses; Lumenis Ltd., Yokneam, Israel), 550-µm end-firing laser fibers (SlimLine; Lumenis Ltd.), and a 26-Fr continuous flow laser resectoscope for enucleation. A 26-Fr nephroscope and a tissue morcellator (Versacut; Lumenis Ltd.) were used for morcellation. We used transurethral resection in saline for coagulation. All BPH cases were enucleated by using the two- or three-lobe technique. A three-way 22-Fr Foley catheter was inserted with continuous bladder irrigation and removed 2 to 3 days after surgery unless there were no complications such as urethral injury or urinary tract infection.
Evaluation after HoLEP was conducted during follow-up visits at 1, 3, 6, and 12 months in almost all patients. At each visit, we performed IPSS and IPSS-QoL evaluations, uroflowmetry, and transabdominal ultrasonography to determine the PVR. If the patient did not visit our institution at the scheduled follow-ups, we used the latest data obtained within 1 year after surgery.

A 26-Fr continuous flow resectoscope, a laser-fiber stabilizing bridge, 120 W Holmium laser (VersaPulse; Lumenis Inc., Israel), a 550-μm end-firing laser fiber (SlimLine; Lumenis Inc.), and a 26-Fr nephroscope were used in all patients. A Lumenis VersacutTM (VersaPulse; Lumenis Inc., USA) and Hawk (Hanghzhou Hawk Optical Inst. Co., China) morcellators were used to morcellate. All surgeries included in this study were performed via the ‘Omega Sign’ technique as described [16 ]. The procedures were performed by a single surgeon (LT) who has experience [18 ] over 700 HoLEP interventions.

All surgical procedures were performed in a routine manner by one urologist (SJO) with the experience of performing more than 100 HoLEP operations as described in detail in previous studies.13 (link)14 (link) First, a 26 Fr resectoscope (Karl Storz GmbH and Co., Tuttlingen, Germany) was inserted into the prostate and bladder. Normal saline was irrigated continuously during enucleation and morcellation. Enucleation of the prostate was performed using a 550-μm end-firing laser fiber (SlimLine, Lumenis Ltd., Yokneam, Israel) and an 80 W holmium neodymium: yttrium-aluminum-garnet laser (VersaPulse Power-Suite, Lumenis Ltd.). Second, tissue morcellation was performed with a VersaCut morcellator (Lumenis Ltd.) through a 0° rectangular nephroscope (Karl Storz GmbH and Co.). At the end of morcellation, a 22 Fr 3-way urethral catheter was inserted into the bladder, and normal saline was connected to the catheter for continuous irrigation.
The urethral catheter was generally removed on the 1^st or 2^nd postoperative day. The patients were discharged if they were able to void without problems and had postvoid residual urine volumes of <50 ml. The pre- and post-operative data, including the parameters of energy used, operative time, duration of hospital stay, intra- and post-operative complications, and duration of urethral catheterization were assessed.

All surgical procedures were performed by one surgeon (S.J.O.) according to the technique described previously [10 (link)]. In brief, anatomical enucleation was adopted using the three-lobe technique. A 26-Fr resectoscope (Karl Storz, Tuttlingen, Germany) was used for enucleation of the prostate. A 550-μm end-firing laser fiber (SlimLine, Lumenis Ltd., Yokneam, Israel) was engaged with an 80-W holmium neodymium:yttrium-aluminum-garnet laser (VersaPulse Power-Suite, Lumenis Ltd.). The energy power was usually set at 2 J and 40 Hz. Continuous irrigation was applied with normal saline during enucleation and morcellation. The mechanical morcellator used was a VersaCut morcellator (Lumenis Ltd.) through a 0-degree rectangular nephroscope (Karl Storz). If the lump was small, it was washed out through the resectoscope sheath naturally. After complete retrieval of the enucleated prostatic tissue from the bladder, usually a 22-Fr 3-way urethral catheter was inserted for continuous bladder irrigation with normal saline. At the end of the operation, the extracted tissues were weighed after removing the irrigation fluid and sent for pathological analysis.