Introduction & Objective : At our institution, two patients with benign prostatic hyperplasia status post UroLift procedure presented with persistent symptoms seeking further treatment. One was found to have evidence of an eroded UroLift clip at the bladder neck that was thought to be contributing to irritative symptoms. The other experienced significant retention requiring intermittent catheterization. Both patients underwent holmium laser enucleation of the prostate (HoLEP) and procedures were videotaped for educational and research purposes.
Methods : Both patients underwent holmium laser enucleation of the prostate performed at a single institution between October 2017 and January 2018. Full video of each procedure was obtained and edited using open source software. Voiding symptoms were assessed preoperatively and postoperatively using validated symptom scores and uroflometry.
Results : Both patients experienced symptomatic relief after HoLEP procedure. Patient 1 experienced improvement in his irritative voiding symptoms with decrease in urinary frequency and dysuria. Patient 2 no longer requires intermittent catheterization and on most recent follow up peak flow was 14 cc/s with voided volume of 343cc and ultrasound post void residual of 77cc.
Conclusions : Holmium enucleation of the prostate can safely be performed in patients who have previously undergone UroLift. UroLift clips have the potential to erode into the bladder neck and may contribute to irritative voiding symptoms.