Calculi in the Prostatic Surgical Bed as a complication after Holmium Laser Enucleation of the Prostate
Urology Journal,
Vol. 15 No. 5 (2018),
26 Mehr 2018
,
Page 238-241
https://doi.org/10.22037/uj.v15i5.3965
Abstract
Purpose: To report de novo calculi in the prostatic surgical bed as a complication of Holmium laser enucleation of the prostate (HoLEP).Materials and Methods: Patients who underwent HoLEP and were enrolled in our Benign Prostatic Hyperplasia (BPH) Database Registry from July 2008 to December 2015 were reviewed. Cases of calculi removal in the prostatic surgical bed were identified. Clinical data, including preoperative evaluation, postoperative symptoms with a detailed history, urinalysis, pathology, cystourethroscopy, and stone analysis were collected and described.
Results: Eight patients were identified including one patient who underwent HoLEP at another hospital. Among the 877 patients in our BPH database, 7 (0.8%) underwent calculi removal in the prostatic surgical bed. Median age was 67.0 years. Median prostatic volume was 75.5mL. The most common symptom was severe stabbing urethral pain (n = 4), with a median of 13 months after HoLEP. Calculi were pedunculated in the prostatic surgical bed or in the bladder neck with a small mucosal connection. Pathology of the resected tissue showed granulation tissue
formation and dystrophic calcification.
Conclusion: Calculi in the prostatic surgical bed or the bladder neck after HoLEP have never been reported previously. Although it is very rare, recurrent urethral pain, persistent pyuria, and recurrent gross haematuria are signs for further investigation. Cystourethroscopy should be performed to rule out the presence of stones. Careful history taking and having an index of suspicion are important for the diagnosis.
How to Cite
References
Floratos DL, de la Rosette JJ. Lasers in urology. BJU Int. 1999;84:204-11.
Schroeck FR, Hollingsworth JM, Kaufman SR, Hollenbeck BK, Wei JT. Population based trends in the surgical treatment of benign prostatic hyperplasia. J Urol. 2012;188:1837-41.
Cornu JN, Ahyai S, Bachmann A, et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications
Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2015;67:1066-96.
Vincent MW, Gilling PJ. HoLEP has come of age. World J Urol. 2015;33:487-93.
Kim M, Lee HE, Oh SJ. Technical aspects of holmium laser enucleation of the prostate for benign prostatic hyperplasia. Korean J Urol. 2013;54:570-9.
Tasci AI, Tugcu V, Ozbay B, Mutlu B, Cicekler O. Stone formation in prostatic urethra after potassium-titanyl-phosphate laser ablation of the prostate for benign prostatic hyperplasia. J
Endourol. 2009;23:1879-81.
Malde S, Rajagopalan A, Koslowski M, Simoes AD, Choi WH, Shrotri NC. Potassium-titanylphosphate laser vaporization of the prostate: a case series of an unusual complication. J Endourol. 2012;26:682-5.
Le Duc A, Gilling PJ. Holmium laser resection of the prostate. Eur Urol. 1999;35:155-60.
van Rij S, Gilling PJ. In 2013, holmium laser enucleation of the prostate (HoLEP) may be the new 'gold standard'. Curr Urol Rep.
;13:427-32.
Tooher R, Sutherland P, Costello A, Gilling P, Rees G, Maddern G. A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia. J Urol. 2004;171:1773-81.
Kabalin JN. Holmium: YAG laser prostatectomy canine feasibility study. Lasers Surg Med. 1996;18:221-4.
Orihuela E, Pow-Sang M, Motamedi M, Cowan DF, Warren MM. Mechanism of healing of the human prostatic urethra following thermal injury. Urology. 1996;48:600-8.
Olvera-Posada D, Villeda-Sandoval C, Ramirez-Bonilla M, et al. Natural history of pyuria and microhematuria after prostate
surgery. Actas Urol Esp. 2013;37:625-9.
Cho KH, Song KH, Chang YS. Study of the Duration of Pyuria after Transurethral Prostatectomy. Korean J Urol. 2007;48:199-
- Abstract Viewed: 991 times
- PDF Downloaded: 396 times