Category: BPH
VS3-9 - Continence preserving Homium Laser Enucleation of prostate - Our technique
Introduction & Objective :
Objectives Holmium laser enucleation of the prostate (HoLEP) was first reported by Gilling et al and several studies have documented its efficacy and safety. Transient urinary incontinence (TUI) has been observed as a bothersome complication of HoLEP in a small number of patients, occurring in a range of 1.3% to 10.7% of reported cases. Although most cases with TUI recover spontaneously within three months, it remains one of the most troublesome complications of this procedure, as it decreases the patients’ quality of life
Methods :
HOLEP was carried out using a pulsed 100 W Holmium:YAG laser machine with a 550 micron end fire laser fiber. 24 Fr Continuous flow resectoscope with laser bridge was used. Proper lignocaine lubricant and Rapid diltation of urethra was done before cystoscopy. Near the spchinter area resection was done at 50 W and most cases completed at 50 W only.Mucosal elevation technique near the apical region of prostate gave a proper landmark for the spchinter. Two or three lobe technique was followed and tissue plain between adenoma and prostate was well maintained and end-firing laser fibre was used like a finger to enucleate the lobes. Enucleation at 50-60W was haemostatic with little need for post op irrigation and long fibre life. Specimen was morcilated out with tissue morcillator Post operatively in most case catheter removal at 36-72 hrs.
Results :
In initial 250 cases – 6 patients had incontinence out of which 5 patients recovered within 1 month with conservative management and 1 patient had prolonged urinary incontinence. Next 250 cases we had 4 cases of transient incontinence. Next 500 cases 3 patients had transient incontinence who recovered within 3 months. 1 patient had transient urinary incontinence in 1001st to 1500th cases. No incontinence was observed thereafter in our study.
Conclusions : Transient urinary incontinence, although a bothersome complication observed after Holep can be minimized with proper selection of patients and certain precautions during the procedures. Resection with reduced Watts at spchinter area, proper plain maintenance is important.
Krishna Mohan Ramaswami
– Senior Consultant Urologist and Transplant Surgeon, MIART, MICC , Thondayadu bypass , calicut , kerala , India, CALICUT, Kerala, India- HP
Harigovind Pothiyedath
– Chief Consultant Urologist and Transplant Surgeon, CALICUT, Kerala, India - PB
Pankaj Bhirud
– Consultant Urologist, Calicut, Kerala, India - MS
Mohammed Saleem
– Consultant Urologist, Calicut, Kerala, India