Greenlight XPS - Step 1 - How I do It

This video shows a greenlight XPS prostate surgery for the treatment of male BPH performed by Dr. Kevin Zorn. In step 1, upon initial cystoscopic entry with the 23F Storz laser resectoscope, care is made to avoid mucosal trauma. This involves not torquing on the bladder neck or median lobe just to visualize the ureteral orfices. This is a common mistake and lends to unnecessary bleeding early during the case. Anatomic referencing (orfice location, bladder trabeculation and diverticulum, bladder stones) should be performed prior to surgery with flexible cystoscopy. Similarly, I highly advocate the use of trans-rectal ultrasonography to accurately measure prostate volume (PV). PV plays a huge relationship to total operative time, energy use, complications - all of which affect surgeon focus and patient conselling. In summary, this video highlights the key aspects of "MARKING THE SPHINCTER AND MAKING SPACE".