Abstract
Purpose: To characterize the role of perineal urethrostomy in patients undergoing HoLEP for BPH symptom relief. Methods: We identified all patients who required the creation of a perineal urethrostomy from a prospectively maintained institutional database between 1998-2017. Patient demographics, as well as operative and postoperative records, were analyzed to evaluate differences in those patients requiring a perineal urethrostomy. Results Obtained: We identified 7 patients who underwent HoLEP and required a perineal urethrostomy. The mean age was 70 years old (range: 61-82 years old). Within this subset of patients, four had previously aborted BPH procedures; two had penile prosthesis and two were morbidly obese. The mean final prostate specimen weight was 111 grams (range: 23-319). The duration of catheterization varied from 37-600 hours. In patients with BMI ≥40kg/m2 , the average duration of catheterization was 588 hours compared 119 hours in patients with BMI <40kg/m2 . At the six-month follow-up, no patient reported daytime incontinence. No strictures, fistulae, or diverticula were identified in these patients. Conclusion: Utilizing a temporary perineal urethrostomy during HoLEP, or any transurethral BPH procedure, for a small subset of patients with challenging anatomy represents an important skill in the endoscopist’s armamentarium. We note no adverse events aside from prolonged urinary catheterization. Surgeons should consider temporary perineal urethrostomy in lieu of aborting the procedure with the knowledge that it is safe and presents minimal long-term risks.
Highlights
Holmium laser enucleation of the prostate (HoLEP) represents a versatile outlet procedure for prostates of all sizes, resulting in a durable reduction in lower urinary tract symptoms related to benign prostate hyperplasia (BPH) [1, 2]
A temporary perineal urethrostomy has been utilized at the time of TURP with success, with the thought that this approach would decrease the rate of urethral stricture disease by limiting the amount of urethra traversed by the scope [4, 5]
The practice of routine perineal urethrostomy at time of endoscopic surgery has been largely abandoned, the utilization of a temporary perineal urethrostomy for men with large prostates or difficult anatomy undergoing HoLEP has been successful in our practice to avoid conversion to an open suprapubic procedure when endoscopic instruments are not long enough to reach the bladder
Summary
Holmium laser enucleation of the prostate (HoLEP) represents a versatile outlet procedure for prostates of all sizes, resulting in a durable reduction in lower urinary tract symptoms related to benign prostate hyperplasia (BPH) [1, 2]. While HoLEP can be performed in prostates of any size, there are limitations to the length of equipment utilized and, in some circumstances, it may. A temporary perineal urethrostomy has been utilized at the time of TURP with success, with the thought that this approach would decrease the rate of urethral stricture disease by limiting the amount of urethra traversed by the scope [4, 5]. The practice of routine perineal urethrostomy at time of endoscopic surgery has been largely abandoned, the utilization of a temporary perineal urethrostomy for men with large prostates or difficult anatomy undergoing HoLEP has been successful in our practice to avoid conversion to an open suprapubic procedure when endoscopic instruments are not long enough to reach the bladder. HoLEP and Urethrostomy we describe our surgical technique and experience in this unique patient population
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