Prostate international · 2025
Holmium laser enucleation of the prostate as a treatment option for patients with concurrent outlet obstruction and bladder diverticulum.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Frumer Michael, Khamaisi Iyad, Levenberg Guy, Creiderman Gherman, Gilad Ron, Shpitzer Sagi A, Aviv Tzach, Krenawi Muhammad, Bercovich Shayel, Dekel Nadav, Tamir Hadar, Hasdai Tomer, Ventura Yossi, Segal Niv, Hendel Hen, Zieber Liran, Baniel Jack, Lifshitz David, Darawsha Abd E, Ehrlich Yaron
Аннотация
BACKGROUND: A bladder diverticulum is a source of infections, urinary stones, and malignancy. Until recent years, patients suffering from large obstructive prostate and diverticulum were treated with open surgery, which also allowed diverticulectomy. The transition to a closed approach has led to diverticulum preservation. The clinical implications of this preservation strategy have not been sufficiently studied.
MATERIALS AND METHODS: A retrospective comparison was made between holmium laser enucleation of the prostate (HoLEP) patients with a diverticulum (≥2 cm) and HoLEP patients without any diverticulum. For each patient with a diverticulum, two patients without a diverticulum who were operated on around the same time were matched (1:2). Patients operated on until March 2022 were included to allow for a relatively long follow-up period.
RESULTS: Out of 602 HoLEP patients, 32 (5%) had a diverticulum ≥2 cm, and they were matched with 64 patients without a diverticulum. The median diverticulum size was 37 mm (interquartile range: 25, 51). A comparison of preoperative data between the two groups revealed no significant differences. Two patients with a diverticulum required a temporary urinary catheter at discharge, but there were no significant differences in surgical, perioperative, or postoperative measures between the two groups, except for a clinically insignificant difference in residual urine volume. With a median follow-up of 3.3 years (interquartile range: 2.5, 4.5), no patient required or was referred for diverticulectomy.
CONCLUSIONS: HoLEP is an effective treatment method for patients with bladder outlet obstruction and concomitant bladder diverticulum. By effectively relieving the bladder outlet obstruction, HoLEP can avoid the need for more invasive surgical interventions.
MATERIALS AND METHODS: A retrospective comparison was made between holmium laser enucleation of the prostate (HoLEP) patients with a diverticulum (≥2 cm) and HoLEP patients without any diverticulum. For each patient with a diverticulum, two patients without a diverticulum who were operated on around the same time were matched (1:2). Patients operated on until March 2022 were included to allow for a relatively long follow-up period.
RESULTS: Out of 602 HoLEP patients, 32 (5%) had a diverticulum ≥2 cm, and they were matched with 64 patients without a diverticulum. The median diverticulum size was 37 mm (interquartile range: 25, 51). A comparison of preoperative data between the two groups revealed no significant differences. Two patients with a diverticulum required a temporary urinary catheter at discharge, but there were no significant differences in surgical, perioperative, or postoperative measures between the two groups, except for a clinically insignificant difference in residual urine volume. With a median follow-up of 3.3 years (interquartile range: 2.5, 4.5), no patient required or was referred for diverticulectomy.
CONCLUSIONS: HoLEP is an effective treatment method for patients with bladder outlet obstruction and concomitant bladder diverticulum. By effectively relieving the bladder outlet obstruction, HoLEP can avoid the need for more invasive surgical interventions.