Holmium laser enucleation of the prostate is an effective treatment in patients with concomitant bladder diverticula and outlet obstruction

Deepak K. Agarwal, Amy Krambeck

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Bladder diverticula can be congenital or secondary to benign prostatic hyperplasia with bladder outlet obstruction, and be a source of high postvoid residuals prompting surgical intervention. We sought to evaluate the outcomes of patients with bladder diverticula undergoing holmium laser enucleation of the prostate (HoLEP) for bladder outlet obstruction. Methods: We retrospectively reviewed HoLEP patients with at least one bladder diverticulum at two high volume institutions. All cases were performed in similar fashion. Preoperative, perioperative, and postoperative patient variables were obtained and assessed. Results: Of 2746 HoLEP patients, 51 were diagnosed with bladder diverticula before surgery. Mean prostate size was 80.8 ± 50.0 g and mean diverticulum size (largest if multiple) was 5.5 ± 2.6 cm. Preoperatively, urinary retention requiring catheterization was present in 28 (55%) patients. In the remainder, mean preoperative AUASI was 19.7, peak flow 7.2 ml/s, and post-void residual (PVR) 365 ml. At most recent follow-up (mean 12.2 months), mean total AUASI was 8.6, peak flow 27.1 ml/s, and PVR 145 ml with 71, 276, and 221% improvement, respectively. All patients were voiding and none required catheterization. Only three (6%) patients required diverticulectomy at a mean of 15.2 months after HoLEP for the following indications: hematuria (one patient) and urinary retention (two patients). Conclusions: HoLEP is an effective method of outlet obstruction treatment in patients with bladder diverticula. Most patients, even with large diverticula, do not require further treatment after the outlet obstruction has been relieved and can avoid more invasive surgical interventions.

Original languageEnglish (US)
Pages (from-to)1-4
Number of pages4
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Oct 31 2017

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Urinary Bladder Neck Obstruction
Solid-State Lasers
Prostate
Therapeutics
Urinary Retention
Diverticulum
Catheterization
Bladder Diverticulum
Prostatic Hyperplasia
Hematuria

Keywords

  • Bladder diverticula
  • BPH
  • HoLEP
  • Outcomes

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Holmium laser enucleation of the prostate is an effective treatment in patients with concomitant bladder diverticula and outlet obstruction",
abstract = "Introduction: Bladder diverticula can be congenital or secondary to benign prostatic hyperplasia with bladder outlet obstruction, and be a source of high postvoid residuals prompting surgical intervention. We sought to evaluate the outcomes of patients with bladder diverticula undergoing holmium laser enucleation of the prostate (HoLEP) for bladder outlet obstruction. Methods: We retrospectively reviewed HoLEP patients with at least one bladder diverticulum at two high volume institutions. All cases were performed in similar fashion. Preoperative, perioperative, and postoperative patient variables were obtained and assessed. Results: Of 2746 HoLEP patients, 51 were diagnosed with bladder diverticula before surgery. Mean prostate size was 80.8 ± 50.0 g and mean diverticulum size (largest if multiple) was 5.5 ± 2.6 cm. Preoperatively, urinary retention requiring catheterization was present in 28 (55{\%}) patients. In the remainder, mean preoperative AUASI was 19.7, peak flow 7.2 ml/s, and post-void residual (PVR) 365 ml. At most recent follow-up (mean 12.2 months), mean total AUASI was 8.6, peak flow 27.1 ml/s, and PVR 145 ml with 71, 276, and 221{\%} improvement, respectively. All patients were voiding and none required catheterization. Only three (6{\%}) patients required diverticulectomy at a mean of 15.2 months after HoLEP for the following indications: hematuria (one patient) and urinary retention (two patients). Conclusions: HoLEP is an effective method of outlet obstruction treatment in patients with bladder diverticula. Most patients, even with large diverticula, do not require further treatment after the outlet obstruction has been relieved and can avoid more invasive surgical interventions.",
keywords = "Bladder diverticula, BPH, HoLEP, Outcomes",
author = "Agarwal, {Deepak K.} and Amy Krambeck",
year = "2017",
month = "10",
day = "31",
doi = "10.1007/s00345-017-2114-5",
language = "English (US)",
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journal = "World Journal of Urology",
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AU - Agarwal, Deepak K.

AU - Krambeck, Amy

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N2 - Introduction: Bladder diverticula can be congenital or secondary to benign prostatic hyperplasia with bladder outlet obstruction, and be a source of high postvoid residuals prompting surgical intervention. We sought to evaluate the outcomes of patients with bladder diverticula undergoing holmium laser enucleation of the prostate (HoLEP) for bladder outlet obstruction. Methods: We retrospectively reviewed HoLEP patients with at least one bladder diverticulum at two high volume institutions. All cases were performed in similar fashion. Preoperative, perioperative, and postoperative patient variables were obtained and assessed. Results: Of 2746 HoLEP patients, 51 were diagnosed with bladder diverticula before surgery. Mean prostate size was 80.8 ± 50.0 g and mean diverticulum size (largest if multiple) was 5.5 ± 2.6 cm. Preoperatively, urinary retention requiring catheterization was present in 28 (55%) patients. In the remainder, mean preoperative AUASI was 19.7, peak flow 7.2 ml/s, and post-void residual (PVR) 365 ml. At most recent follow-up (mean 12.2 months), mean total AUASI was 8.6, peak flow 27.1 ml/s, and PVR 145 ml with 71, 276, and 221% improvement, respectively. All patients were voiding and none required catheterization. Only three (6%) patients required diverticulectomy at a mean of 15.2 months after HoLEP for the following indications: hematuria (one patient) and urinary retention (two patients). Conclusions: HoLEP is an effective method of outlet obstruction treatment in patients with bladder diverticula. Most patients, even with large diverticula, do not require further treatment after the outlet obstruction has been relieved and can avoid more invasive surgical interventions.

AB - Introduction: Bladder diverticula can be congenital or secondary to benign prostatic hyperplasia with bladder outlet obstruction, and be a source of high postvoid residuals prompting surgical intervention. We sought to evaluate the outcomes of patients with bladder diverticula undergoing holmium laser enucleation of the prostate (HoLEP) for bladder outlet obstruction. Methods: We retrospectively reviewed HoLEP patients with at least one bladder diverticulum at two high volume institutions. All cases were performed in similar fashion. Preoperative, perioperative, and postoperative patient variables were obtained and assessed. Results: Of 2746 HoLEP patients, 51 were diagnosed with bladder diverticula before surgery. Mean prostate size was 80.8 ± 50.0 g and mean diverticulum size (largest if multiple) was 5.5 ± 2.6 cm. Preoperatively, urinary retention requiring catheterization was present in 28 (55%) patients. In the remainder, mean preoperative AUASI was 19.7, peak flow 7.2 ml/s, and post-void residual (PVR) 365 ml. At most recent follow-up (mean 12.2 months), mean total AUASI was 8.6, peak flow 27.1 ml/s, and PVR 145 ml with 71, 276, and 221% improvement, respectively. All patients were voiding and none required catheterization. Only three (6%) patients required diverticulectomy at a mean of 15.2 months after HoLEP for the following indications: hematuria (one patient) and urinary retention (two patients). Conclusions: HoLEP is an effective method of outlet obstruction treatment in patients with bladder diverticula. Most patients, even with large diverticula, do not require further treatment after the outlet obstruction has been relieved and can avoid more invasive surgical interventions.

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