V08-06 LASER-ASSISTED ENDOSCOPIC RESECTION OF LARGE PROSTATES WITH A STRAIGHT FIRING FIBER. A QUARTER OF A CENTURY FOLLOW-UP

Abstract

INTRODUCTION AND OBJECTIVE: Prostate enlargement treatment for benign disease has been to remove the adenoma from the capsule and all efforts are to control bleeding. Technology evolution along with prostate awareness programs favored endoscopic procedures, for the Transurethral Resection (TUR) to become the Gold Standard. A perfect view has been a central point in achieving the 100% success rate. In 1995, AUA 90th annual meeting, the initial experience in large prostate glands was presented with the Neodymium-YAG laser and a straight firing fiber with the rationale to coagulate in depth from the prostatic urethra towards the branches of the large arteries entering into the capsule, then followed by a conventional TUR. METHODS: A 50-Year-old male presented with Hematuria. An extensive high-grade urothelial lamina propria penetrating tumor over the submucosal left ureter was Holmium laser treated. A narrow bladder neck with an altered uroflowmetry and 76% residual urine was present. The first three-month control Urethrocystoscopy, showed no tumor and the prostate gland was operated with the aforementioned technique. Both, the 1995 AUA and 2019 video, will be shown simultaneously, the latter with immediate (Fig. 1) and 6 months retrograde flexible cystoscopy results (Fig. 2). Procedures have been carried out with negligible bleeding all along. Straight Firing fiber was chosen again to reproduce the same condition, but today with the Holmium laser. RESULTS: 784 cases, from 62 - 77-year-old, otherwise healthy patients with prostates from 40 to 140 gr have been operated with this technique. Blood transfusion has been required in 0.3%. Uroflow measurements have immediately increased and remained. CONCLUSIONS: The technique is simple, any laser and fiber might be utilized, allows “through air” vision along the TUR Gold Standard and it has taken the test of time. Art work form Salvador Gil Vernet private collection will be presented. (Figure Presented).