Stenting in Cases of Ureteral Orifice Damage during Laser Enucleation of the Prostate for BPH: Is it Worth It?
In several patients with benign prostatic hyperplasia (BPH), the ureteral orifices may be in close proximity to the enlarged prostate due to considerable intravesical prostatic protrusion. In such cases, ureteral orifices are at risk of damage as they become involved in the surgery. We aimed to answer the question whether upper urinary tract stenting is necessary when ureteral orifices get damaged during thulium laser enucleation of the prostate (ThuFLEP).
Our retrospective study included 340 patients aged 67.2 (54-89) years with infravesical obstruction (IPSS>20, Qmax<12) due to BPH. Patients with urethral strictures, bladder stones or a history of prior prostate surgery were excluded. For enucleation, we used Urolase (NTO IRE-POLUS, Russia), a 120 W thulium fiber laser, and a 600 μm fiber. In 7 cases, we observed intraoperative damage of the ureteral orifice. Following surgery, upper urinary tracts were monitored using ultrasonography on day 1, 3, 7, 14 and 30. Preoperatively and six months after surgery we evaluated IPSS, QoL, Qmax and post-void residual volume. All statistical analyses were performed using SPSS Statistics 22.0 (SPSS Inc., Chicago, IL, USA). A p-value of 0.05 was chosen as a threshold for statistical significance.</p>
Three patients with damaged ureteral orifices underwent intraoperative upper urinary tract stenting. During follow-up, no patients with a stent developed pelvicalyceal system dilatation or showed any signs of urine flow inhibition. The stents were removed two weeks after surgery. Ultrasonography showed no dilatation during further follow-up. In 4 cases, a decision was made to forgo stenting. Two patients had no signs of pelvicalyceal system dilatation within one month of follow-up. Two other patients without stents developed pelvicalyceal system dilatation (renal pelvis up to 1.5 cm; renal calyx up to 0.5 cm) with no clinical manifestation. Fourteen days following surgery, dilatation persisted in one patient. One month following surgery, no patients showed pelvicalyceal system dilatation. Six months after surgery, we observed a statistically significant improvement in IPSS, QoL, Qmax and post-void residual volume in all the patients (p<0.05).</p>
Our experience shows that stenting in cases of ureteral orifice damage during ThuFLEP is not necessary. Associated asymptomatic pelvicalyceal system dilatation can not be considered an indication for stenting. However, it still requires thorough ultrasound monitoring.