Step 5. Posterior dissection F. Gomez Sancha

When all lateral and anterior aspects of the adenoma are free, the cresta urethralis is cut at 6 o’clock and the posterior aspect is liberated. It then becomes possible to flip the adenoma into the bladder by lifting it and pushing it carefully with the scope. The 6 o’clock attachment at the bladder neck is cut to deliver the adenoma “en bloc” into the bladder.

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The bladder is entered anteriorly and cut toward 7 and 12 o’clock (Picture 8). A similar process is carried out on the contralateral side, and then, the crista urethralis is cut and the posterior aspect developed with mechanical dissection until the adenoma can be flipped into the bladder (Picture 9). The remaining attachment at 6 o’clock is cut to release it into the bladder and morcellation follows (Picture 10).

Figure procedure-steps