Surgery in Motion Eraser Laser Enucleation of the Prostate: Technique and Results Stephan Hruby a,y, *, Manuela Sieberer a , Tobias Scha ¨tz a , Neil Jones b , Reinhold Zimmermann a , Gu ¨nter Janetschek a , Lukas Lusuardi a,y a Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria; b Department of Pediatric Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria 1. Introduction Surgical treatment of benign prostatic obstruction (BPO) secondary to benign prostatic hyperplasia (BPH) is changing from conventional, monopolar, transurethral resection of the prostate (TURP) to minimally invasive surgical therapies (MIST) such as holmium laser enucleation (HoLEP) or GreenLight lithium borate laser vaporization of the prostate [1]. The clinical reasons for this altered approach include less morbidity with these therapies compared to conven- tional TURP, less perioperative bleeding, shorter periods of catheterization, and a shorter hospital stay. In addition, EUROPEAN UROLOGY 63 (2013) 341–346 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted August 23, 2012 Published online ahead of print on August 29, 2012 Keywords: Prostate Benign prostatic hyperplasia Benign prostatic obstruction Laser surgery Please visit www.europeanurology.com and www.urosource.com to view the accompanying video. 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 Æ 11.43 min. Mean serum hemoglobin was 15.1 Æ 0.87 g/l before, and 14.39 Æ 0.94 g/l after surgery. Mean blood loss was 115.90 Æ 98.12 ml. No blood transfusions were required. All patients had their cathe- ters 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 complica- tion, 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. # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. y Lukas Lusuardi and Stephan Hruby contributed equally to the investigation and the manuscript. * Corresponding author. Paracelsus Medical University Salzburg, Department of Urology and An- drology, Mu ¨ llner Hauptstrasse 48, 5020 Salzburg, Austria. Tel. +43 662 4482 57439; Fax: +43 662 4482 2971. E-mail address: stephan.hruby@gmx.at (S. Hruby). 0302-2838/$ – see back matter # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.eururo.2012.08.049