THULIUM LASER PROSTATECTOMY FOR 165 GM PROSTATE PRESENTING WITH ACUTE RETENTION OF URINE

A 79 year old gentleman preented with urinary retention.He was evaluted and found to have gross prostatomegaly on USG KUB (175 gm ) with normal upper tracts and 75 ng/ml Sr PSA. We got his surgical profile done and he was found to be fit for surgical interevntion.We usually do TRUS before every laser prostatectomy; we on TRUS found that his prostate was homogeneous with volume of 165 gm.

He was taken up for LASER PROSTATECTOMY and TRUS guided biopsy to take biopsy from the peripheral zone. We did LASER surgery with 2-μm -continuous wave thulium laser to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. 

A 70-W, (thulium) laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. The prostatic pieces were pushed into the bladder and later removed with the morcellation. 

The surgery was uneventful and the patient recovered well after the surgery.

We have rarely encountered bleeding. Saline was used for irrigation and hence no TUR syndrome occurs. Blood transfusion rate is less than 0.5%.We have even done patients on antiplatelet agents and patients with cardiac comorbdities.Recently we operated a 90-year old man with retention. The procedure was uneventful and the patient voided well after the surgery