Introduction & Objective :
Holmium laser enucleation of the prostate (HoLEP) is a safe, effective for benign prostatic hyperplasia (BPH) in any size gland. Several challenges for endoscopic management secondary to the bulk of tissue occupying the urethra. Some of these include prostate cancer and radiotherapy. In this case, we aimed to present HoLEP to the patient who had radiotherapy due to prostate cancer.
A 67 year old male patient referred to our clinic with lower urinary tract symptoms, high post voiding residuel urine volume and hematuria. The patient underwent radiotherapy due to prostate cancer 2 years ago. In his cystoscopy, prostate lobes had asymmetric hyperplasia, especially in left side of the prostatic urethral space. HoLEP procedure was performed using a 120-W holmium: YAG (yttrium aluminum garnet) laser (Versapulse, Lumenis Inc., Santa Clara, CA, USA); a 550-nm end-firing fiber (SlimLineTM 550, Lumenis Inc.). Continuous flow 26 F resectoscope (Karl Storz, Tubingen, Germany), a rigid nephroscope with a 5-mm working channel (Karl Storz), a Versacut tissue morcellator (Lumenis Inc.) were also used. Power settings were 37.5 Watt (1.5J energy, 25 Hz frequency) in the right pedal and 100 Watt (2 J energy, 50 Hz frequency, and short-500 µs pulse width combination) in the left pedal.
The enucleation time was minutes. 65 g of prostate tissue was morcellated in 6 minutes. Estimated blood loss was less than 100 mL. The catheter was removed two days. Post-void residual at three-month follow-up was 30 mL with International Prostate Symptom Score of 3 and Quality of Life score of 1.
HoLEP can be used safely in patients with pelvic radiotherapy as well as in many difficult cases.
Serdar Yalcin– Urologist, Ankara, Ankara, Turkey
Engin Kaya– Urologist, Ankara, Ankara, Turkey
Eymen Gazel– Urologist, acibadem, Ankara, Ankara, Turkey
Halil Cagri Aybal– Urologist, Ankara, Ankara, Turkey
Lutfi Tunc– Urologist, Gazi University School of Medicine Dept. of Urology, Ankara, Ankara, Turkey
Ankara, Ankara, Turkey
Im working İn Acibaem University Ankara hospital as Asist.Prof in Ankara,Turkey