V8-10: Holmium laser enucleation of prostate in patients with metallic prostatic stent insitu.
VideoIntroductions and Objectives
Permanent prostatic stents lack long-term efficacy in management of bladder outlet obstruction. We describe a technique utilizing high power holmium laser for endoscopic removal of permanent prostatic stent and enlarged prostate in a patient with bothersome lower urinary tract symptoms and bladder outlet obstruction after previous management with permanent prostatic stent.
A 71 year old male patient presented with bothersome lower urinary tract symptoms of 2-year duration. Inspite of being on medical management for bladder outlet obstruction for a year, he had recurrent hematuria and urinary tract infections over a period of last 4 months. He had a history of permanent metallic stent placement 10 years back for symptomatic bladder outlet obstruction. His uroflow was obstructed and sonography revealed enlarged prostate with stent and high post void residual urine. The metallic stent was seen on x-ray. Associated co-morbidities included diabetes, hypertension and ongoing anti-platelet medications. A 100 W holmium laser with 550-µ laser fiber was used for procedure. The patient underwent holmium laser enucleation of prostate with simultaneous fragmentation of prostatic stent. Thereafter the stent was separated from enucleated tissue with holmium laser in bladder. Small prostate tissue with incorporated stent pieces and stent particles were removed mechanically with grasping forceps and remaining prostate adenoma was morcellated. The detail surgical technique is shown in the video. Literature review was performed focusing on articles on removal of permanent prostatic stent.
At 10 month of follow-up, patients had symptomatically improved with American urological association symptom score of 3, maximum uroflow rate of 21.7 ml/sec and post void residual urine of 31 ml. In the literature, we could identify only two case reports employing low power holmium laser for fragmenting prostatic stent.
High power holmium laser can be successfully used to remove a permanent metallic stent in prostate during holmium laser enucleation of prostate.