Greenlight XPS - Step 9

This video showd a greenlight XPS prostate surgery for the treatment of male BPH performed by Dr. Kevin Zorn.

In step 9, the case is complete. The importance of this step is significant to reduce post-operative bleeding. Depending on the type of anaesthesia, the patient may force significantly during this part of the surgery which may increase capillary pressure and bleeding. As such, any simple tricks to help ensure optimal hemostasis is welcomed.

With over 10 years experience with laser BPH surgery, I have adopted a few elemental techniques to reduce unwanted bleeding. These include-

- pre-filling of the bladder prior to case completion. The use of hydro-static pressure really helps temponade any capillary vessels. This is especially important to use in men undergoing general anasthesia when upon extubation, rapid increased in abdominal pressures from gag/cough reflex increase bleeding. As such, I typically await just near the time of extubation to place in the final 20F 2-way Foley.

- Atraumatic Foley insertion with a stylet. Simple placement of the foley can occasionally irritate the raw, prostatic fossa, especially in large prostates with impressive concave defects. As such, the stylet-guided Foley insertion into a bladder with greather than 500mL really ensures the proppoer position of the catheter.

- Balloon prostate compression. Immediately once the Foley is inserted, the balloon is inflated with 30mL of saline. The balloon is withdrawn to compress the bladder neck and a wet 4x8" gauze is used to tie around the catheter. From experience, grip on the catheter to produce adequate compressive pressure is best with SILICONE catheters. Use of the cheaper latex catheters unfortunately is very slick and the noose knot of the gauze does not hold. As such, I strongly advise those I train to use silicone 20F 2-way Foleys. Once the knot is tied, a gentle compressive pressure is created by pulling the Foley down while pushing up the knot to pucker the glans penis.

- Prior to going to the recovery room, I reconnect the inflow valve of the irrigation to again fill the bladder. Up until the patient being taken to the recovery room, I maintain the pressure gradient to optimize hemostasis. Like when we remove IV and arterial lines, pressure for 2-5 minutes is held - bleeding time. This allows the human body to create a basic clot. This same principle is upheld with the combined over-filling on the bladder along with balloon prostate compression.


In summary, this video highlights the key aspects of FOLEY INSERTION AND MILD PROSTATE FOSSA COMPRESSION.