Water enucleation of the prostate
Embodiments of the present invention provide improved methods and apparatus of treating the prostate. In many embodiments, at least a portion of the prostate is enucleated with a water jet, in order to decrease the invasiveness of the surgery. The access to the prostate can be provided with one or more of open surgical access, percutaneous access, or urethral access. The prostate can be enucleated such that an inner portion of the prostate comprising adenomatous tissue of the prostate is separated from a portion an outer the prostate comprising the capsule. In many embodiments, the patient is treated with energy of the water jet configured to separate the capsule from the inner tissue of the prostate and to inhibit cutting of blood vessels.
1. A method of enucleating at least a portion of a prostate, the prostate comprising a capsule and an inner layer of prostate tissue, the method comprising:
advancing a first probe at least partially into the patient;
resecting a urethra of the patient at a first location and a second location with a first water jet provided by a first orifice of the first probe; and
separately enucleating a plurality of lobes of the prostate by separating the capsule from the inner layer of prostate tissue with a second water jet provided by a second orifice of a second probe.
2. A method as in claim 1 , wherein the first probe or the second probe is advanced into the patient with one or more of open surgical access, percutaneous access or urethral access.
3. A method as in claim 1 , the first location is situated near a bladder neck of the urethra and the second location is situated near a verumontanum and toward the bladder neck from the verumontanum.
4. A method as in claim 1 , wherein resection of the urethra comprises a plurality of resections extending between the first location and the second location and wherein the plurality of resections extend from the urethra to the capsule.
5. A method as in claim 1 , wherein an energy of the second water jet is adjusted to separate the capsule from the inner tissue and inhibit resection of the capsule and blood vessels.
6. A method as in claim 1 , wherein the first or second water jet comprises a divergent stream.
7. A method as in claim 1 , wherein an energy of the first or second water jet is adjusted based on an image of an entrainment region of the first or second water jet when the first or second probe has been inserted at least partially into the urethra.
8. A method as in claim 1 , wherein the first water jet is adjusted to a first amount of energy to resect the urethra at the first location and the second location and the second water jet is adjusted to a second amount of energy to separate the outer capsule of the prostate from the inner tissue.
9. A method as in claim 1 , wherein the first probe is advanced into a natural opening of the urethra to access the urethra and wherein the urethra is resected at the first location and the second location with the first probe with the first water jet extending to a side of the first probe to resect the urethra and wherein the capsule is separated from the inner layer with the second probe having the second water jet extending from the end of the second probe at a different angle than the first probe.
10. A method as in claim 1 , further comprising morcellating at least one of the plurality of enucleated lobes of the prostate, wherein the morecelating occurs after separately enucleating at least one of the plurality of lobes of the prostate.