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Introduction: The vapoenucleation of the prostate using green laser is an alternative hybrid technique between vaporization and enucleation. It consists of vaporizing the lateral lobes and enucleating the median lobe. The advantages compared with photoselective vaporization of the prostate (PVP) are: a fairly fast operation, low reoperation rates, it is suitable for large glands and provides pathology specimen. The aim of this video is to demonstrate the vapoenucleation technique step-by-step., Methods: The surgery was performed with a 532-nm lithium triborate laser (GreenLight XPS 180W, American Medical Systems, Minnetonka, Minnesota), MoXy side-fire laser fiber at power settings: 180 W for cutting, 35 W for coagulation and a Piranha morcellation system (Richard Wolf GmbH, Germany)., Case Report: A 68-year-old patient presented with lower urinary tract symptoms secondary to benign prostatic obstruction. The prostate volume was 88 mL, PSA of 3.4 ng/mL, the peak urinary flow rate (Q max ) was 7 mL/s, the postvoid residual volumen was 160 mL and international prostate symptom score was 22., Results: The total operative time was 72 minutes, total energy employed was 354 kJ and the pathology report showed no evidence of prostate cancer (35 g). The bladder catheter was removed at 24 hours postsurgery and the patient was discharged 48 hours postoperative without complications. Three months later all the parameters showed significant improvement (PSA: 1.02 ng/mL, international prostate symptom score: 4, Q max : 43 mL/seg and postvoid residual volumen: 15 mL)., Conclusion: Green laser vapoenucleation of the prostate represents a safe alternative technique for the complete removal of adenomatous prostate tissue, regardless of gland size, and it is particularly advantageous for the treatment of large prostates. This technique can also be used as an intermediate step during the learning curve of "en bloc" green laser enucleation of the prostate (GreenLEP). These promising results warrant further studies to assess long-term outcomes., (Copyright © 2018. Published by Elsevier Inc.)

Objective: Background:After EEP (HoLEP, ThuLEP, GreenLEP or bipolar) the enucleated tissue is removed through a process of mechanical morcellation. Morcellation is the last, and very important, step in EEP procedures. It introduces additional time, and the possibility for complications exists. Although this is not a difficult procedure, it requires a learning curve that can pose a challenge for inexperienced surgeons. There are two types of morcellation systems: oscillating and reciprocating (depending on blade movement)., Objective: To demonstrate tips and tricks for safe and efficient morcellation after EEP and to share our experience with the oscillating morcellation system., Material and Methods: Four hundred and thirty-six patients were treated with green laser enucleation of the prostate by 3 surgeons with the en bloc technique between June 2013 and November 2016. After completing the enucleation procedure we removed the adenoma with an oscillating mechanical morcellator (Piranha, Richard Wolf, Germany). We have reported our experience (including the learning curve) and collected multiple videos exemplifying not only proper techniques for safe morcellation, but also possible problems and their solutions. The authors have compiled their collective experience to offer tips and tricks as well as a practical approach to trouble shooting and problem solving of the morcellation procedure., Results: The median morcellation time was 5.00 minutes (3.00; 10.0) and the median morcellation efficiency was 11.0 g/min (7.70; 16.0). Complications included 2 cases of superficial bladder injuries and no bladder perforations., Conclusion: Morcellation is a safe and appropriate procedure to remove the adenoma after endoscopic enucleation of the prostate. However, without taking proper precautions major complications can occur. This video serves as a guide for safe morcellation after EEP and also offers practical advice to help avoid the most common complications in this procedure., (Copyright © 2018. Published by Elsevier Inc.)