Reply by authors

摘要

For holmium laser enucleation of the prostate one of the principal pitfalls of the traditional 3-lobe method is difficulty in recognizing the level of surgical capsule of the median lobe when cutting through the prostatic tissues down to the posterior prostatic wall. Using our technique, the distal posterior surgical capsule of the median and lateral lobes can be exposed quickly and safely, as described. Once the distal plane is developed, the median and lateral lobes are leveraged up off the posterior surgical capsule step by step toward the bladder neck, with enough operating space created. In our experience the contact between the adenoma and the surgical capsule is often loose and can be separated easily by the endoscope beak. If the prostate is adherent to the surgical capsule and not easy to bluntly lift up, it is also safe to dissect the adherent tissues along the exposed capsule. Sometimes the prostatic tissues near the bladder neck are difficult to separate from the capsule, and we will then incise the prostatic tissues at the 5 o'clock position from the apex to the bladder neck along the already developed plane, with the surgical capsule of the bladder neck exposed and freed. To avoid penetrating the surgical capsule of the median lobe, the operator should always perform the procedure along the exposed capsule and move the endoscope beak forward following the adjacent prostatic tissues already leveraged up. Of course, the operator should also have a good idea of the contour of the prostate.