V06-01 WHAT TO DO WHEN UNABLE TO REACH THE BLADDER DURING HOLMIUM LASER ENUNCLEATION OF THE PROSTATE (HOLEP): AN INCISION-FREE APPROACH

Abstract

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-01 WHAT TO DO WHEN UNABLE TO REACH THE BLADDER DURING HOLMIUM LASER ENUNCLEATION OF THE PROSTATE (HOLEP): AN INCISION-FREE APPROACH Deepak Agarwal, and Marcelino Rivera Deepak AgarwalDeepak Agarwal More articles by this author , and Marcelino RiveraMarcelino Rivera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The situation of not being able to reach the bladder during HoLEP is a rare situation. Currently, this situation requires some external incision (temporary perineal urethrostomy (PU) or conversion to open/MIS simple prostatectomy) which requires additional catheterization time. We present an alternative, incision-free technique for this situation to complete HoLEP transurethrally. METHODS: We present a case of HoLEP in a 73 year old male with a 225 ml gland on preoperative imaging in which the laser scope could not reach the bladder due to urethral length. We utilized the early apical release technique, and dissected to the bladder through the anterior plane. As this is the shortest distance across the prostate to the bladder endoscopically, we were able to reach the bladder anteriorly and complete the HoLEP without additional incisions. This also enabled us to perform catheter removal promptly after surgery. RESULTS: The total procedure time was 146 minutes, enucleation time was 97 minutes and morcellation time was 24 minutes. All of the 199 grams of enucleated tissue was benign adenoma on final pathology. In the 15 minutes between procedure end time and extubation, continuous bladder irrigation was run through a 22 french three-way urinary catheter. The catheter was removed prior to extubation and the patient voided within 2 hours. At two week follow-up, the patient was voiding without issue, having only minimal stress urinary incontinence, and no hematuria. CONCLUSIONS: We propose the technique of first following anterior plane to the bladder after early apical release as an when the laser scope cannot reach the bladder transurethrally at the time of HoLEP. The shorter distance of the anterior plane from the apex of the prostate to the bladder neck, opposed the longer distance through the urethral lumen is the likely reason for the success of this approach. This anterior-first technique may avoid external incisions and prolonged catheter time from a temporary PU or open/MIS prostate enucleation in these rare cases. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e449-e449 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepak Agarwal More articles by this author Marcelino Rivera More articles by this author Expand All Advertisement Loading ...