Holmium Laser Enucleation and Bipolar Plasma Vaporization of Prostate

HoLEP and BPVP were done by two experienced urologists, respectively. Two experienced urologists performed more than 100 HoLEP and BPVP before this study, respectively. We consider that two experienced urologists overcame the learning curve of these surgical technique. HoLEP was performed using a 120 W Holmium:YAG laser (VersaPulse PowerSuite, Lumenis Surgical, San Jose, CA, USA) with a 550-nm end-firing fiber (SlimLine, Lumenis). A 26-Fr continuous-flow resectoscope with saline irrigation was used. The laser settings were 2.5 J and 40 Hz. After enucleation of the adenoma and control of bleeding, enucleated adenomas were removed from the bladder using a mechanical tissue morcellator (Versa-Cut, Lumenis) with an indirect nephroscope. [8 (link)] The BPVP technique required the Olympus SurgMaster UES-40 bipolar generator (Olympus, Tokyo, Japan) under continuous flow saline irrigation with a standard button- or mushroom-type vapo-resection electrode. During BPVP, the button-type electrode presenting a plasma corona on its surface was moved forward and backward in close contact with the prostatic tissue, which was vaporized layer-by-layer until reaching the surgical prostate capsule. The BPVP output was controlled flexibly to achieve a bloodless operation field for proper tissue vaporization and simultaneous hemostasis.