PMID- 33561473
OWN - NLM
STAT- MEDLINE
DCOM- 20220228
LR  - 20220228
IS  - 1527-9995 (Electronic)
IS  - 0090-4295 (Linking)
VI  - 153
DP  - 2021 Jul
TI  - Challenging Case of Holmium Laser Enucleation of the Prostate after Prior 
      Prostatic Focal Laser Ablations and Rezum.
PG  - 358
LID - S0090-4295(21)00155-2 [pii]
LID - 10.1016/j.urology.2021.01.046 [doi]
AB  - BACKGROUND: Holmium laser enucleation of the prostate (HoLEP) is an effective, 
      size independent procedure for management of benign prostatic hyperplasia 
      (BPH).(1) Additionally, HoLEP is able to be performed successfully after prior 
      surgical BPH treatments without complication and a low rate of long term 
      retreatment.(2) OBJECTIVES: To demonstrate challenging case of HoLEP in a patient 
      with multiple, prior ablative BPH surgeries. MATERIAL: A 63 year old male with 
      refractory lower urinary tract symptoms after 2 focal laser ablations, one Rezum 
      treatment, and medications (silodosin 8 mg and tadalfil 5 mg) presented to our 
      clinic with obstructive lateral lobe BPH. The prostate was approximately 50 ml on 
      digital rectal exam and preoperative cystoscopy demonstrated prostatic urethral 
      calcifications and lateral lobe hypertrophy. Preoperative AUA symptom score 
      (AUAss) was 12, peak urinary flow was 5.3 ml/s. A HoLEP was performed to 
      alleviate the patients lower urinary tract symptoms and allow him to stop his 
      medications. RESULTS: Total procedure time was 44 minutes, with enucleation time 
      of 20 minutes and morcellation time of 1 minute. The HoLEP was started as a 2-cut 
      technique, however due to poor surgical planes we changed to top-down 
      technique.(3) There was a small, posterior, nonclinically significant capsular 
      perforation. Five grams of benign adenoma were removed. Patient was discharged on 
      the day of surgery. Catheter was removed on postoperative day four due to patient 
      desiring to return home (over 150 miles away) for catheter removal, instead of 
      having it done in our clinic on postoperative day one. At most recent follow-up, 
      AUAss was 5 and peak urinary flow was 13.2 ml/s. CONCLUSION: HoLEP can be 
      performed after prior, multiple BPH treatments successfully. These can prove to 
      be more challenging cases. Prior ablative techniques can lead to fibrosis of 
      transition zone tissue and distort the natural plane between adenoma and surgical 
      capsule.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Agarwal, Deepak K
AU  - Agarwal DK
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
FAU - Krambeck, Amy E
AU  - Krambeck AE
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, IN. 
      Electronic address: gecoots2@gmail.com.
LA  - eng
PT  - Case Reports
PT  - Video-Audio Media
DEP - 20210206
PL  - United States
TA  - Urology
JT  - Urology
JID - 0366151
RN  - 0 (Steam)
SB  - IM
MH  - Ablation Techniques/*methods
MH  - Humans
MH  - *Laser Therapy
MH  - Lasers, Solid-State/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Prostatectomy/*methods
MH  - Prostatic Hyperplasia/*surgery
MH  - Reoperation
MH  - Steam
EDAT- 2021/02/10 06:00
MHDA- 2022/03/01 06:00
CRDT- 2021/02/09 20:09
PHST- 2020/09/11 00:00 [received]
PHST- 2021/01/16 00:00 [revised]
PHST- 2021/01/25 00:00 [accepted]
PHST- 2021/02/10 06:00 [pubmed]
PHST- 2022/03/01 06:00 [medline]
PHST- 2021/02/09 20:09 [entrez]
AID - S0090-4295(21)00155-2 [pii]
AID - 10.1016/j.urology.2021.01.046 [doi]
PST - ppublish
SO  - Urology. 2021 Jul;153:358. doi: 10.1016/j.urology.2021.01.046. Epub 2021 Feb 6.