Professional education
An excellent overview of Anatomic Endoscopic Enucleation of the Prostate by Dr. Enikeev
Dr. Fernando Gómez Sancha · ICUA
Dr. Fernando Gómez Sancha · YouTube
Language: English. YouTube audio metadata.
Professional education. May contain surgical footage.
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About this video
Dr Enikeev's overview of anatomical endoscopic enucleation of the prostate, recorded from a congress in Israel where benign prostatic hyperplasia was the central theme. The description explains that the talk was shared on the channel with the speaker's agreement. It provides context for the lecture without summarising individual study results.
Recently, I was invited to participate in a congress in Israel, where BPH was the central theme. I enjoyed Dr. Enikeev's overview of anatomic endoscopic enucleation of the prostate. I asked him if he was happy to show his talk on this channel, and he graciously agreed. I hope you find it as interesting as I did.
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No clinical case details have been extracted for this video.
Original title and description on YouTubeSource checked: 2026-10-06.
Available transcript · English
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- now we'll talk about endoscopic ulation of the press so and um maybe a new standard for BB let's discuss it let's think about it so but I think it's an important sign when J presented at water one and water two trials for aquablation now we have water three trials and the goal of this trial is to compare aquation with holl so you see that is becoming new standard of treatment so and the question is is every process is eligible for scopic equation of the process so we have a lot of debates during International meetings and now I will try to answer to all these questions so 1986 1986 40 years ago the first endoscopic ination was performed in Japan by Hira what he did he did at that time he used a electr
- loop perform endoscopic ination but at that time mercel was not developed so he lived in performed scoping ination and leave tissue at 12:00 position and then when the loop Resa all this tissue he published this data but as morcel was not developed the technique was not so popular in that moment and not only 1998 Peter Gilling from New Zealand used holum Yak laser from luminous Israel company and the luminist presented the first Urological Mercator that moment and after that and the scopic inflation it became more and more widespread all over the world so what is that that in make endoscopic nucleation of the FR be acceptable by Urological Community all over the world it's minimally invasive recovery is quick long and
- short-term outcomes are satisfaction so once again if we look at the guidelines we will see we will see that both European and American guidelines accept endoscopic ination of the prostate as a size independent option the only one difference that European guidelines accept all accepts all energy sources while American guid L focuses only on laser laser techniques sometime ago we were invited by chesar Capon for debates in European Neurology of science so for which laser is the best for and theop inflation so it was my privilege to be together with Fernando Gomez sanch with Thomas kman so we discussed which energy source is better to Lum yakum fiber pum Yak laser which laser is the best for endoscopic
- regation of the process poed and I think the answer is still was given by Thomas kman in 2016 so that nucleation is a nucleation no matter what kind of energy source you use so Professor Herman quoted the famous poet G Trin who said that rose is a rose and there is nothing to add so inflation is ination and there is nothing to add so sometime ago we were involed in first more so it was holum gak laser with Moses effect and fulum fiber big multier stud we compared and found that once again all energy sources are comfortable hospital stays tress uring contents no matter what kind of energy source use functional comes the same but what is the difference the difference is learning curve and we conducted also trial on
- thisp and we found for that for tum laser tum fiber laser it's easier to learn endoscopic infation of the we know that there is a stereotype that endos scoping colation has rather steep learning curve so new energy sources allow to minimize this learning curve new Thum fi laser and today we will see this procedure I hope we'll have this life surgery and we will see all the advantages of this energy source but this energy source allows it to for quicker learning this is the main advantage so if we compare endoscopic cation of the prate with trans resection so if we talk about short-term outcomes of course they are comparable all patients start urinate but long-term outcomes please read our meta analysis in War
- Journal P it's meta analysis tpy and and ination on the process all benefits long-term outcomes all benefits go to Copic inflation of the process long-term outcomes better terization after incop inflation 95% of cases one day hospitalization one day Hospital stay one day so we know for example in Germany due to Insurance system they keep the C for two days but it's only for the insurance system and they need to do that complications last after and the stopping poal proc artile function better after endoscop ination of course it was proven also in our trials recurrence rate of course and it goes without saying that it's better to remove that denoma completely than just to Res a part of it so relapse after
- transaction up to 10% in some trials up to 15% a lot so now for example an AAL Clinic there is no we do only endoscopic plation for all the process no matter what SI sometime ago we have a debate in Austria with great expert and my friend Mario Sofer regarding small glass what about extra small glass less than 30 would you do T or and scopic cation of the process for these glands uh Dr gessen what about you what do you prefer to do in such cases okay so it's it's clear so some studies were conducted and I promised Mario to presented the studies so this study come from Lun from our Turkish friends uh they compared data patient hold it for less than 30 more than 30 no difference in terms of functional outcomes
- some intraoperative complication rization were higher in small glands less than 30 but it goes without saying that should be done in experienced SC that PPH is not formed yet and it's difficult to separate a noral from the capsu but in experienced SC it's absolutely doable another studies come from Asia from South Korea from Japan big number of patients less than 30 more than 30 no difference in functional comes no difference in complications conclusion effective in all sides of the process so if we compare oscopy ination once again we don't call it poip because poip isum laser ination now we have many energy sources we say endoscopic anatomical endoscopic ination of prostate if we compare it to
- TP one day calization instead of two or three days shorter Hospital State less hemoglobin loss the hemoglobin drop efficacy shortterm comparable but all benefits for longterm go for holip more tissue remov goes without saying if we compare holip for endoscopic ination for glands less than 30 more than 30 of course operation time is sure potential risk of inoperative implications cation rization is higher of course so and it goes without what about huge glands more than 80 Cub CM such studies of course were conducted so if we talk about functional outcomes the same calization of course one day after endoscopic infation of the process complication better after endoscop equation of course function
- better after endoscop equation recurrence rates also better after open Simple Prost attack this is all the data from meta analysis not just from some studies nice study from also friend so he conducted a study compersion nucleation for glands less than 200 and more than 200 stress Ur contance functional outcomes was absolutely comparable now study trans Mitchell hre from United States also length less than 300 CM cubic cm and more than 300 all the same data all the same functional outcomes is all the same what about what is the biggest gland which was operated on with endoscopic infation across it so we look at the data we'll see 436 the largest one is 696 sometime AG here in asheron Relic did the procedure
- for 650 Cub CM so we see that it's absolutely doable and the patient next day went home and he was more than happy so but of course now robotic approach is becoming more and more widespread and we talk about robotic simple prostectomy what about compersion in nucleation with robotic simple proc okay so functional outcomes the same operating time well better it's better with the stoping theorization once again better Hospital State better complications transfusion rate less dur in continence there is a stereotype and uh we will talk about it during the presentation so there is a stereotype that after H it there isas incence high incence rate it's not so it's not so and I hope that during our meeting today we'll present all the data
- it's not really so in experienced hands functional outcomes same recurrence rate if we do it with robotic approach simple PR detec we clearly see all the models remove them it's absolutely the same like with endoscope ination of so if we compared once again if you comp compare inflation with robotic simple process ta short operative time shorter calization less transfusion rate efficacy comparable if we compare nucleation for smaller and larger glands okay of course for larger glands operating time is short longer similar characterization a little bit higher hogin loss efficacy safety absolutely comp what about Salvage nucleation can we do endoscopy compulation of the prostate after T simple prostate ectomy
- can we of course we can and we conducted with our German colleagues we conduct a study on this topic and we found that absolutely no differences primary or Salvage and the scope inflation all the outcomes are the same noal difference even now we have a uh met analysis systematic RW on this topic more energy sources required for Salvage uh surgery uh of course risk of Ural strcture SK is the repeat surgery and we know that any any repeat procedure on the urra has a higher risk of Ural strcture upward but no significant difference in all other aspects is it possible to do endoscopic infation after eurolift and we see such patients sometimes yes it's possible and also the study was published on this
- topic so it's absolutely uneventful and it's possible to do cation the same nucleation was rather quick and the same goes for merelation uh it's a good question it's a good comment so you don't break the morcel you you break you can break the blade the blade during morcellation and of course this is an important comment so when you do such procedures and we talk with yon about it so we we always ask to bring another blade and it should be at a hand to change it quickly during the procedure focal therapy for prostate cancer is becoming more and more widespread the question can we do endoscop ination after focal therapy yes we can I did it after to my patients after focal n after focal culation also
- am from United States form and scopic she published this data after focal laser oblation and it was absolutely uneventful possible no complications were observed PR the today we will talk about it Dominic will present the data on this topic so the question is okay the patient have after this procedure can we do endoscopic ination of the process and answer is also yes we can so and all the data show that when comparision patients primary and after arabization all the data function outcomes are all the same your original stance we know this patients also is it possible to perform anoscopic ination I see yes you're on agree with me absolutely it's possible to perform endoscopic cation after R sense and we
- also have these data on this topic absolutely uneventful procedure with short characterization and no complication to obser medication therapy so some surge say whoa some medication therapy can can affect uh so should we do it and also studies were performed on this topic so and the final conclusion and of course five five Inhibitors on the spotlight here are effect the surgery the answer is no so in acation efficacy mulation efficacy bleeding Hospital stage Rober complications no the next question CR bi so we have a lot of after bias Fusion bi schematic bi can we do call it right after this procedure Professor ster Mario what do you think for sure so what's the problem sure it's a good it's a good question
- it's a good answer so and but there are two different opinions on this matter in one study authors said that it's better to wait six months after biopsy because the risk of inorder complications in their study was higher on the other hand in other studies show that absolutely no difference and frankly I think uh please surgeons who perform the scoping flation of the prostate please raise your hands who do not wait any time after Prost so yes most of the hands we we don't wait there is no need to wait any time after PR biopsy we can perform ination sure so is it possible to combine I am finishing so I just want to clarify and to sum it up is it possible to combine nucleation with other surgeries why not sure and there are
- more and more centers who combine the surgery with others so they do this procedure together and show that it's absolutely doable no no effect onization no effect on complications so it's absolutely doable procedure so dear friends I'm SU up so now we see that and the scoping is becoming more and more widespread all over the world and here in Israel and all over the world once again today we will present different ination techniques state-of-the artum laser nucleation Electro enucleation is it possible of course and you will see it in one of the best hands in the world will be presented by Thomas kman and we also will do live surgery with new fiber laser it's a new player on the market absolutely new laser we will
- present it and present the procedure with this laser so don't stop we see all the advantages of this new method and moving forward and the road will appear by itself thank you for your attention any questions any questions from the audience great presentation I agree with everything s and uh you know said 600 gr prostate 800 gr prostate it's a bit scary takes longer but as we learned from the openo the larger the prostate the more satisfying the plane that we have okay smaller is much harder to reach satisfying plane so it may be it will take longer but you'll have a great plane larger bres AB absolutely that that what I was trying to highlight uh can you give the microphone to Mario ditri congratulations for
- organizing this event for your initiative to make it popular in our country and you