New super-pulse thulium laser for the treatment of benign prostatic hyperplasia and bladder stones: our first experience

In this video, we presented our first experience with Soltive™ Premium (Olympus), a new 60-W super-pulse thulium fiber laser that can be used in the treatment of benign prostatic hyperplasia (BPH) and urinary tract stones. We describe the case of a 63-year-old man with persistent voiding urinary symptoms despite medical therapy with dutasteride and tamsulosin. Ultrasonography estimated a prostatic volume of 90 ml and revealed the presence of four bladder stones. We used the new 60-W super-pulse thulium fiber laser (Soltive™ Premium) with a 550 μm disposable laser fiber and a 28 Fr continuous flow resectoscope. The enucleation was performed according to Gilling's three-lobe technique. Total operative time was 110 minutes. Laser setting was 1 Joule × 60 Hertz (60 Watt) short pulse for cystolithotripsy and 1 Joule × 30 Hertz (30 Watt) long pulse for prostate enucleation. Morcellation was performed with the Versacut system (Lumenis). Postoperative catheterization time was 48 hours and the patient was discharged the day after catheter removal. There were no perioperative complications. Pre- and post-procedure haemoglobin levels were 15.6 and 15.4 g/dl, respectively. At follow-up 1 month later, the patient reported good urinary flow with mild irritative symptoms that did not require any specific therapy. The uroflowmetry showed a maximum voiding flow rate of 24 ml/s with a postvoid resisdual (PVR) volume of 10 ml. Soltive™ Premium may represent a feasible and effective tool for the surgical management of BPH and bladder stones. This technology seems particularly advantageous for high intra-operative safety and may become an important milestone for BPH treatment.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

Video can be found at http://www.ceju.online/journal/2021/laser-thulium-bladder-stones-benign-prostatic-hyperplasia-thulep--2116.php