Early anterior detachment of the adenoma: a novel approach for en bloc thulium laser enucleation of the prostate

摘要

The procedure starts with a circular incision of the apical mucosa at the level of the seminal colliculus. The main novelty is the first identification of the capsular plane on the anterior aspect of the adenoma at the 12 o’clock position, starting from the prostatic apex and reaching the bladder neck. Then, the early detachment of the anterior plane is carried out in the direction of the two lobes at 10 o’clock and 2 o’clock positions. Afterwards, the enucleation is completed dissecting all the posterior aspect of the adenoma with a lateral dissection of the lobes from the early incision of the mucosa above the seminal colliculus towards the previously identified planes. The left lobe is enucleated by developing the surgical plane from 5 o’clock to 2 o’clock position and the right lobe enucleation is carried out following the plane from 5 o’clock to 10 o’clock position.