Abstract
Introduction
Benign prostatic hyperplasia (BPH) can be associated with marked intravesical protrusion, placing ureteral orifices at risk for injury during bladder outlet procedures.
Aim
To determine whether ureteral stenting is necessary in cases of ureteral orifice injury during laser enucleation.
Materials and methods
Retrospective study included 465 patients with bladder outlet obstruction (IPSS > 20, Qmax < 10) secondary to BPH who were managed with thulium fiber laser (ThuFLEP) or holmium laser enucleation of the prostate (HoLEP). In seven patients, the ureteral orifices were injured during surgery (3—HoLEP; 4—ThuFLEP). Three of the seven patients underwent intraoperative stenting of the upper urinary tract (1—HoLEP; 2—ThuFLEP). In four cases, stenting was not performed (2—HoLEP; 2—ThuFLEP). The follow-up period was 6 months.
Results
Postoperatively, none of the patients with a stent in the upper urinary tract exhibited signs of pelvicalyceal system (PCS) dilatation or inhibited urine flow from the kidney (assessed with abdominal ultrasound at 1, 3, 10, and 30 days after surgery). In two patients without stents, follow-up revealed no dilatation of the PCS. The other two patients without stents developed asymptomatic dilatation of the PCS (the pelvis—up to 1.5 cm; the calyx—up to 0.5 cm). At 1 month after surgery, no patients had dilatation of the PCS.
Conclusions
Upper urinary tract stenting in cases of intraoperative ureteral orifice injury during laser enucleation of the prostate for BPH may not be warranted.
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References
McDougal WS (1942) Campbell-Walsh urology, tenth edition international edition. Elsevier, Philadelphia
Kuntz RM, Lehrich K, Ahyai S (2004) Does perioperative outcome of transurethral holmium laser enucleation of the prostate depend on prostate size? J Endourol 18(2):183–188
Selzman AA, Spirnak JP (1996) Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol 155(3):878–881
Rausch S, Gakis G, Stenzl A (2014) Transurethral resection of bladder tumors: management of complications. Urologe A 53(5):695–698
O’Conor VJ (1951) Bilateral intramural strictures of the ureters after transurethral resection of the prostate. JAMA 145:1249–1251
Welliver C, Helo S, McVary KT (2017) Technique considerations and complication management in transurethral resection of the prostate and photoselective vaporization of the prostate. Transl Androl Urol 6(4):695–703
Hwang CE, Lipman GS, Kane M (2015) Effect of an emergency department fast track on Press-Ganey patient satisfaction scores. West J Emerg Med 16(1):34–38
Nanavati AJ, Prabhakar S (2014) Fast-track surgery: toward comprehensive peri-operative care. Anesth Essays Res 8(2):127–133
Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64:118–140
Gravas S, Cornu JN, Drake MJ, Gacci M, Gratzke C, Herrmann TRW, Madersbacher S, Mamoulakis C, Tikkinen KAO (2018) EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO) 2018. In: European Association of Urology Guidelines 2018 Edition. Volume presented at the EAU Annual Congress Copenhagen 2018. European Association of Urology Guidelines Office, Arnhem, The Netherlands
Graham JB (1961) Electroresection Injury of the ureteral orifice. J Urol 86(5):539–547
O’Conor VJ (1962) Bilateral stenosis of ureteral orifices. Complication of transurethral resection of the prostate. JAMA 182(8):866–868
Altok M, Sahin AF, Gokce MI et al (2017) Ureteral orifice involvement by urothelial carcinoma: long term oncologic and functional outcomes. Int Braz J Urol 43(6):1052–1059
Mano R, Shoshany O, Baniel J et al (2012) Resection of ureteral orifice during transurethral resection of bladder tumor: functional and oncologic implications. J Urol 188(6):2129–2133. https://doi.org/10.1016/j.juro.2012.08.006
Davis JP (1951) Ureteral injury by transurethral electroresection and coagulation. In: Read at annual meeting, Western Section, American Urological Association, Sun Valley, Idaho
Elsamra SE, Leavitt DA, Motato HA et al (2015) Stenting for malignant ureteral obstruction: tandem, metal or metal-mesh stents. Int J Urol 22(7):629–636
Lange D, Bidnur S, Hoag N et al (2015) Ureteral stent-associated complications–where we are and where we are going. Nat Rev Urol 12(1):17–25
Dołowy L, Krajewski W, Dembowski J et al (2015) The role of lasers in modern urology. Cent Eur J Urol 68(2):175–182
Kuntz RM (2006) Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). Eur Urol 49:961–969
Bruyere F, Puichaud A, Pereira H et al (2010) Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up. Eur Urol 58:207–211
Minagawa S, Okada S, Morikawa H (2017) Safety and effectiveness of holmium laser enucleation of the prostate using a low-power laser. Urology 110:51–55
Shah HN, Mahajan AP, Hegde SS et al (2007) Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int 100(1):94–101
Kuo RL, Kim SC, Lingeman JE et al (2003) Holmium laser enucleation of prostate (HoLEP): the Methodist Hospital experience with greater than 75 gram enucleations. J Urol 170:149–152
Enikeev D, Glybochko P, Okhunov Z et al (2018) Retrospective analysis of short-term outcomes after monopolar versus laser endoscopic enucleation of the prostate: a single center experience. J Endourol 32(5):417–423
Hojgaard M, Mikines KJ (2010) Ureteral injuries during photoselective vaporization of the prostate. Scand J Urol Nephrol 44(4):265–268
Lask D, Abarbanel J, Luttwak Z et al (1995) Changing trends in the management of iatrogenic ureteral injuries. J Urol 154:1693–1695
Connolly JG, Morales A, Minnaker L (1971) The origin of regenerative bladder mucosa after partial mucosal strip**. Invest Urol 8:481–487
See WA (2000) Distal ureteral regeneration after radical transurethral bladder tumor resection. Urology 55(2):212–215
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Enikeev, D., Glybochko, P., Rapoport, L. et al. Need for upper urinary tract stenting in cases of ureteral orifice injury during laser enucleation of the prostate. Int Urol Nephrol 50, 2173–2177 (2018). https://doi.org/10.1007/s11255-018-2007-6
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DOI: https://doi.org/10.1007/s11255-018-2007-6