26f continuous flow resectoscope

After obtaining informed consent from all patients, HoLEP was performed by using a 140-W Multipulse HoPLUS laser (Jena Surgical/Asclepion Laser) and a 550-nm bareended, reusable laser fiber (Jena Surgical) with the patient under general or spinal anesthesia. All surgical procedures were performed by a single surgeon using the three-lobe technique. A 24-F (Wolf) or 26-F continuous flow resectoscope (Karl Storz) was used for the enucleation stage. The morcellation stage was performed with a rigid nephroscope (Karl Storz) with a 5-mm working channel. Power settings were 140 W for the left (for enucleation) (4 J energy, 35 Hz frequency) and 60 W for the right pedal (for coagulation) (2 J energy, 30 Hz frequency). A multicut integrated tissue morcellator (Jena Surgical) was used for morcellation. The tips and tricks applied when we encountered difficult morcellation are summarized in Fig. 1. The morcellator blade was changed after every 300 g of morcellated prostate tissue, in accordance with the manufacturer's recommendation. A 22-F foley catheter was placed in all patients after HoLEP surgery. The patients were discharged on the first postoperative day with the catheter removed.

TURP was performed as per standard techniques using a 26F continuous flow resectoscope (Storz, Tuttlingen, Germany). Resection was performed using a standard tungsten wire loop with a mono-polar cutting current of 120 W and coagulating current of 80 W. HoLEP was performed as described by Gilling, with some modifications [11 (link)]. After dividing the prostate into anatomical lobes, enucleation of each lobe was performed in a retrograde fashion using a high-powered holmium laser (80–100 W), delivered by a SlimLine 550-mm fiber (Lumenis, Inc., Yokneam, Israel) through the 26F continuous flow resectoscope system. For tissue morcellation and retrieval, we used a 26F nephroscope with a VersaCut Tissue Morcellator (Lumenis, Inc.). PVP was performed using an 80-W potassium-titanyl-phosphate laser delivered by a GreenLight system (GreenLight PV; Laserscope, San Jose, CA, USA). The laser was delivered through a 600-µm side-deflecting fiber. A standard 23F continuous flow resectoscope with a laser bridge was used for this procedure and sterile 0.9% saline solution for irrigation.
TURP and HoLEP were performed on hospitalized patients and PVP was performed in the day-surgery center. In the TURP and HoLEP groups, the urethral catheter was removed on the day urine became sufficiently clear and in the PVP group, on the first postoperative day.