Eraser laser enucleation of the prostate: technique and results

Abstract

Background: Eraser, a 1318-nm diode laser, has been used for 15 yr for resection of lung metastases. It was recently introduced in urology for small kidney tumors and for the treatment of benign prostatic obstruction.

Objective: To demonstrate on video our technique of Eraser laser enucleation of the prostate (ELEP) and report our experience.

Design, setting, and participants: From June 2010 to October 2011, 43 consecutive patients were prospectively evaluated. All of them had lower urinary tract symptoms suggestive of benign prostatic obstruction and a mean prostate size of 59.9 ml (range: 34-89 ml) on transrectal ultrasound. Their mean prostate-specific antigen value was 3.4 ng/ml (range: 0.8-5.0 ng/ml); mean maximum flow rate (Q(max)), 6.9 ml/s (range: 2-11 ml/s); mean International Prostate Symptom Score (IPSS), 25.9 (range: 18-32); and mean postvoid residual (PVR), 170.5 ml (range: 60-330 ml).

Surgical procedure: The details of the technique are shown on video.

Outcome measurements and statistical analysis: Success was defined as patients being able to void with improved IPSS, Q(max), PVR volume, and ameliorated quality of life.

Results and limitations: The mean operating time was 67.0 ± 11.43 min. Mean serum hemoglobin was 15.1 ± 0.87 g/l before, and 14.39±0.94g/l after surgery. Mean blood loss was 115.90 ± 98.12 ml. No blood transfusions were required. All patients had their catheters removed within 2 d and were able to void spontaneously after this time. Significant improvements were noted in Q(max), quality of life, IPSS, and PVR volume from baseline to each follow-up time point. Based on the validated Clavien-Dindo system, we observed one grade 1d complication, one grade 2 complication, and one grade 3b complication.

Conclusions: ELEP is a safe and reproducible method for relieving bladder outflow obstruction and lower urinary tract symptoms. Its advantages include minimal blood loss, short catheterization time, and a brief hospital stay.