To determine the rate of the urethral stricture (US) and bladder neck contracture (BNC) between patients who undergo Holmium Laser Enucleation of Prostate (HoLEP) surgery with 26Fr vs. 28Fr resectoscope sheaths (RS). Studies report rates of 2.8-4.4% and 3.6-5.4% for US and BNC, respectively. To date, there are no studies that have shown the difference between resectoscope sheath size and urethral complications.
We retrospectively reviewed charts of patients who had HoLEP surgery between August 2015 to June 2018, by a single surgeon. Prior history of US or BNC were excluded. The operative set-up for a HoLEP includes Ho:YAG laser, urethral dilation, a 26Fr or 28Fr continuous flow RS, and a tissue morcellator. Primary endpoints include postoperative US or BNC. Secondary endpoints include postoperative catheterization time, success of voiding trial and urinary incontinence. Statistical analysis was performed using appropriate methods.
Out of 502 HoLEP patients, 339 consecutive patients had surgery with 28Fr RS (Group A) and 163 consecutive patients had surgery with a 26Fr RS (Group B). Twelve patients (A) and three patients (B) had post-op US (p=0.41). Eight (A) and zero (B) patients had post-op BNC (p=0.0585). SUI at 6 weeks, 3-6 months, and 1 year, was present in 15.9% (both A & B), 6.5% (A) vs 6.1% (B) (p=0.88), and 3.2% (A) vs 1.8% (B) (p=0.564), respectively. Both blood loss and change in hemoglobin were higher in 28Fr group with no significant difference in rate of transfusion. Conclusions Resectoscope sheath size had no impact on the rate of US or BNC, however lower incidence in the 26Fr sheath cohort for both. 28Fr sheath had larger change in hemoglobin levels and estimated blood loss, but the higher rate of transfusion was not statistically significant. No difference in the stress incontinence rates, length of stay, and enucleation rates.
Journal of endourology. 2020 Sep 01 [Epub ahead of print]
Kim Huynh Thai, Jacob Carl Smith, Jack Stutz, John Sung, Courtney Shaver, Marawan El Tayeb
Baylor Scott and White Central Texas, 293755, Urology, 2401 S 31st St, Temple, Temple, Texas, United States, 76508-0001; ., Baylor Scott and White Central Texas, 293755, Urology, Temple, Texas, United States; ., Waco, Texas, United States; ., Texas A&M University Health Sciences Center, 12333, Bryan, Texas, United States; ., Baylor Scott and White Central Texas, 293755, Research Institute , Temple, Texas, United States; ., Baylor Scott and White Central Texas, 293755, Urology, Temple, Texas, United States; .