Urethral Complications Post-Holmium Laser Enucleation of the Prostate (HoLEP), A Seven-Year Experience - Beyond the Abstract
Enucleation is usually done in standard two lobe retrograde enucleation technique. Holmium laser energy settings of 80 and 40 W at a power setting of 2J and frequency of 40 and 20 HZ respectively are used through 550-micron laser fiber. Storz ™ laser resectoscope sheath of either 28 or 26 fr was often used Morcellation was performed for HoLEP using PiranhaTM morcellator system (Richard Wolf GmbH, Knittlingen, Germany). Three-way 22 fr Foley catheter was always inserted after surgery for continuous bladder irrigation.
Our results: Among 566 patients with at least follow up of 12 months included in the study, a total of 28 (4.94%) patients had urethral complications. Nineteen (3.3%) and eight (1.4%) patients suffered postoperative urethral stricture (US) and bladder neck contracture (BNC) respectively while one patient (0.17%) had both US and BNC complications. Among the 19 patients with US, 11 patients had denovo stricture while 8 patients had intraoperative diagnosed US.
US presentation and diagnosis were early at 6 weeks follow up visit in 10 (50%) patients, between 6-week and 6-month follow up in 6 (30%) patients, and late presentation after 6 months in 4 (20%) patients. BNC was diagnosed before 6 months follow up in 6 (66%) patients while it was later than 6 months in 3 (34%) patients.
Among the US patients, US was bulbar in 9 (45%) patients, penile in 6 (30%) patients, at the fossa navicularis at 3 (15%) patients and bulbo-membranous in 2 (10%) patients.
In patients with US, urethral dilatation under local anesthesia with Van Buren dilators was initially performed in 17 (85%) patients. With median follow up of duration of 11 months (range 6-30 months), dilatation was sufficient in 14 (70%) patients while 3 (15%) patients required internal endo-visual urethrotomy (DIVU) after failed dilatation. Other 3 (15%) patients had DIVU from the start. All of them had endoscopic bladder neck incisions (BNI) with satisfactory results.
Written by: Mohamed Elsaqa, MD & Marawan M. El Tayeb, MD, Baylor Scott & White Medical Center, Temple, Texas
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