The T-incision: A Practical Approach to Initiating Apical Dissection in Prostate Enucleation

Holmium:YAG laser enucleation of prostate (HoLEP) and thulium fiber laser enucleation of prostate (ThuFLEP) are advanced surgical techniques for treating benign prostatic obstruction, both being forms of Anatomical Endoscopic Enucleation of Prostate.These procedures have evolved to provide enhanced efficacy, reduced operation times, and improved continence outcomes.One key factor for preserving continence is early apical release (EAR), a delicate technique that involves releasing the apical mucosa to prevent damage to the external urethral sphincter.This videoarticle explores a practical and safe technique involving a T-incision-combining anterior commissurotomy and anterior plane dissection-performed at the beginning of the enucleation process.Two cases, one using ThuFLEP and the other HoLEP, were edited to emphasize the T-incision's role in facilitating EAR.Results demonstrated that both techniques utilized the T-incision to ease the dissection of the external sphincter complex, improving enucleation and connecting the lateral to anterior planes.The study found differences between the two lasers, with ThuFLEP offering better coagulation and precision, and HoLEP excelling in dissection and tissue preservation.Both patients had short hospital stays, rapid catheter removal, and full continence by postoperative day 10.The T-incision, especially during the learning phase of the procedure, aids in smoother dissection, facilitates easier alignment of enucleation planes, and may accelerate a surgeon's learning curve.This video-article highlights the replicability and benefits of the T-incision in both HoLEP and ThuFLEP surgeries.