V06-08 SALVAGE ENBLOC LASER ENUCLEATION OF PROSTATE AFTER PROSTATIC ARTERY EMBOLIZATION

Abstract

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-08 SALVAGE ENBLOC LASER ENUCLEATION OF PROSTATE AFTER PROSTATIC ARTERY EMBOLIZATION Nicholas Smith, Jonathan Katz, and Hemendra Shah Nicholas SmithNicholas Smith More articles by this author , Jonathan KatzJonathan Katz More articles by this author , and Hemendra ShahHemendra Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though not currently recommended as a treatment for benign prostatic hyperplasia by the American Urological Association (AUA), prostatic artery embolization (PAE) is often selected, in and out of clinical trials, as an option in men who have large prostate volumes >40 mL, surgical comorbidities, and anticoagulation dependence. Current literature suggests that 20-36% patients will fail to respond to PAE and will require surgical management for their enlarged prostate. Examination of prostate tissue after PAE show necrosis and granulomatous reaction, raising concern for any subsequent surgical intervention. Holmium laser enucleation of prostate (HoLEP) is a surgical option for BPH patients that the AUA recommends for prostates of all sizes. Patients that have failed PAE may turn to HoLEP since it is the next least invasive surgical option for massively enlarged prostates. For this reason, we present a video demonstrating our experience performing a salvage HoLEP after PAE. METHODS: An 85 year old wheelchair-bound male with a history of dementia, open cystolithalopaxy two years prior complicated by a vesico-cutaneous fistula, and chronic urinary retention and recurrent urosepsis. He underwent PAE nine months prior to presentation, however failed subsequent voiding trials, experienced recurrent urosepsis, persistent fistula drainage, and required chronic urethral catheterization that resulted in hypospadias. The patient and family desired for the patient to be catheter-free and elected HoLEP. His prostate volume was 135 cc with intra-prostatic cavities secondary to PAE. We utilized the Moses Pulse 120-Watt laser with a 550-micron laser fiber at 2 Joules and 30 Hz. The enucleated prostate was morcellated with VersaCut Morcellator. RESULTS: Despite embolization and diffuse necrosis throughout the specimen, the surgical capsule was preserved throughout. The procedure was notable for minimal bleeding due to the vascularity of the prostate after embolization. Procedure time was 90 minutes and estimated blood loss was 20 mL. Pathology demonstrated BPH, inflammation, necrosis, and embolization spherules. The patient was discharged home on first postoperative day after a successful voiding trial with a PVR of 0 mL. At two-week follow up, the patient’s family states that he voids volitionally, with minimal incontinence. CONCLUSIONS: This video demonstrates that HoLEP after PAE can be safely performed and may be an excellent salvage surgical option for such patients. Despite tissue changes induced by embolization, the surgical capsule is preserved in our experience. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e451-e451 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Smith More articles by this author Jonathan Katz More articles by this author Hemendra Shah More articles by this author Expand All Advertisement Loading ...