V06-07 BLADDER INJURY DURING PROSTATIC ADENOMA MORCELLATION FOLLOWING THULIUM LASER ENUCLEATION OF THE PROSTATE

Abstract

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-07 BLADDER INJURY DURING PROSTATIC ADENOMA MORCELLATION FOLLOWING THULIUM LASER ENUCLEATION OF THE PROSTATE Serena Maruccia, Paolo Spiga, Maria Chiara Clementi, Giancarlo Galbiati, and Stefano Casellato Serena MarucciaSerena Maruccia More articles by this author , Paolo SpigaPaolo Spiga More articles by this author , Maria Chiara ClementiMaria Chiara Clementi More articles by this author , Giancarlo GalbiatiGiancarlo Galbiati More articles by this author , and Stefano CasellatoStefano Casellato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endoscopic enucleation of the prostate (EEP) is one of the most preferred minimally invasive surgical technique for benign prostatic hyperplasia (BPH) treatment. Capsular perforation, superficial bladder mucosal injury, ureteral orifice injury and morcellator malfunction are potential perioperative complications of EEP. Morcellation of prostatic adenoma is the most worrisom stage of the whole procedure and bladder injury may occur in 0.5% to 18.2% of cases. This Video shows the clinical management of bladder wall injury during morcellation. METHODS: The video, recorded in 2020, refers to a Thulium laser enucleation of the prostate (ThuLEP) performed in a patient suffering from lower urinary tract symptoms due to BPH. Enucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 800 µm Thulium laser fiber. Once the median and lateral lobes have been enucleated, the external sheath is removed and the nephroscope is inserted to facilitate morcellation. Under continuous inflow irrigation, the Cyber Blade TM morcellator (manufactured by Quanta System, Samarate, Italy) is introduced. A 3.5-MHz convex abdominal ultrasound transducer is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance. RESULTS: Despite ultrasound is an effective tool that makes the procedure safer, a bladder injury occurred. We managed the accident by stopping the suction and removing the morcellator blade from the lesion's site. A low power coagulation was performed on the bed and on the margins of lesion with Thulium laser. A postoperative ultrasound revealed no evidence of the pelvic and perivesical fluid. A catheter has been left on site for 36 hours.Patient was discharged on the second postoperative day being clinically asymptomatic. CONCLUSIONS: Extra attention should be paid during morcellation. In order to avoid bladder injuries, optimal hemostasis and bladder distention should be achieved before morcellation. Morcellation should be performed at a safe distance from the bladder mucosa. Superficial injuries may be treated with laser and should be managed conservatively with an indwelling catheter. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e450-e451 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Serena Maruccia More articles by this author Paolo Spiga More articles by this author Maria Chiara Clementi More articles by this author Giancarlo Galbiati More articles by this author Stefano Casellato More articles by this author Expand All Advertisement Loading ...