Bipolar "Button" Plasma Vaporization of the Prostate (BPVP) for BPH hillebrander.de
The use of lasers to perform photoselective vaporization of the prostate PVP has been widely accepted as a safe and effective treatment for benign prostatic hyperplasia with very few reported complications. To date, most Vaporisation der Prostata in Kirov the published data report outcomes for the W potassium-titanyl-phosphate laser.
A more potent laser, the W GreenLight HPS, was introduced in and provides more efficient vaporization of prostatic tissue and decreased operating times.
Despite these benefits, the increased energy applied to the prostate evokes concerns of potential serious complications, including capsular perforation and injury to adjacent structures.
We report a rare but serious complication of GreenLight HPS PVP resulting in prostatic capsular Vaporisation der Prostata in Kirov with urinary extravasation, presenting with bilateral thigh urinomas and osteitis pubis.
A previously healthy year-old man presented for treatment of his symptomatic benign prostatic hyperplasia BPH. Initially he had bothersome obstructive urinary symptoms, an International Prostate Symptom Score IPSS of 22 severely symptomatica postvoid residual PVR volume of to cc and a prostate size of 38 cc. He was started on an alpha-blocker, given clean intermittent catheterization CIC and counselled Vaporisation der Prostata in Kirov surgical options for management.
Unfortunately, the complete details of the surgical procedure are not known as it was performed Vaporisation der Prostata in Kirov an outside institution in another country.
On postoperative day 2, his Foley catheter was removed and he was discharged with no scheduled follow-up. Within hours after discharge, the patient was unable to void so he decided to re-initiate CIC on his own accord. Upon returning home on postoperative day 4, he presented to a local emergency department with ongoing retention and dysuria. A computed tomography CT scan revealed inflammatory changes suspicious for infection, however urine culture failed to grow an offending organism.
An indwelling Foley catheter was placed and antibiotics were initiated. Ten days later, after confirming sterile urine cultures, the Foley catheter was removed and the antibiotics were discontinued. Two weeks postoperatively he was voiding volitionally with mild stress incontinence and a PVR of 30 cc. One month postoperatively, he presented to our emergency department with bilateral thigh swelling, an increased white blood cell count His urine culture was positive for multi-drug resistant E.
His CT cystogram Fig. Cystoscopic images demonstrated a large anterior perforation of the capsule surrounded by necrotic prostatic tissue and magnetic resonance imaging showed evidence of osteitis pubis. A computed tomography cystogram, demonstrating bilateral fluid collections in the medial thigh, revealed to be infected urinomas.
Voiding cystourethrogram demonstrating extravasation of urine into the adductor compartment of the thigh. Following 6 weeks of broad-spectrum antibiotic treatment and 4 months Vaporisation der Prostata in Kirov Foley catheterization with suprapubic urinary diversion, follow-up imaging demonstrated a persistent anterior prostatic capsule urine leak. After failure of conservative management, the patient went on to have open operative fistula repair with a peritoneal interposition flap.
Visualization of the prostate during the procedure revealed an atrophic appearing gland with a mm long anterior capsular defect surrounded by necrotic, distorted tissue and in direct communication with an area of the pubic symphysis devoid of periosteum. Post-repair imaging confirmed closure of the fistulous tract with no ongoing extravasation of urine.
The pelvic Vaporisation der Prostata in Kirov is resolving, however, the patient Vaporisation der Prostata in Kirov to suffer from stress urinary incontinence, mild erectile dysfunction that responds to phospho-diesterase type 5 inhibitor therapy Vaporisation der Prostata in Kirov anejaculation that is new since the PVP procedure.
Most of the published data for PVP include outcomes for the W potassium-titanyl-phosphate KTP laser; this laser was first introduced in the early s and uses the green spectrum of light at a wavelength of nm. Compared to TURP, studies have demonstrated that the W KTP laser has a superior safety profile 1 and encouraging postoperative results, including reduced catheterization time, hospital stay 2 and transfusion requirement.
The evolution of Vaporisation der Prostata in Kirov has occurred rapidly in an effort to improve efficacy and decrease operating time. Interestingly, it seems that the depth of tissue coagulation does not exceed 1 to Vaporisation der Prostata in Kirov mm regardless of the power level used, suggesting that coagulation depth may be a function of wavelength and not higher power output. A valid critique of the GreenLight HPS laser is that randomized, prospective studies with long-term follow-up are scarce.
Of note, more patients in the laser cohort suffered from dysuria postoperatively and more required a reoperation Vaporisation der Prostata in Kirov the study period of 36 months. With the U. Ultimately, the safety and efficacy of the GreenLight laser depend on the operator.
Adjustable power settings on these devices allow flexibility, if appropriate, to utilize higher power in situations where faster work is desired. If the high power setting is too close to the capsule, there may be an increased risk of serious complications, including prostatic capsular perforation and injury to adjacent structures. The case presented here is one of these serious but rare complications. This case report demonstrates a number of important issues. Failure to recognize prostatic capsular perforation at the time of surgery can lead to serious complications.
Also, poor continuity of care, due to patient and physician factors, increased morbidity and delayed diagnosis. Finally, GreenLight PVP is an evolving field in endourology, and it is important to evaluate safety and efficacy as experience with this technology Vaporisation der Prostata in Kirov. Competing interests: None declared. This paper has been peer-reviewed.
National Center for Biotechnology InformationU. Can Urol Assoc J. MaysonMD, and Ercole F. Author information Copyright and License information Disclaimer. Correspondence: Dr. David Harriman, Laurel St.
This article has been cited by other articles in PMC. Abstract The use of lasers to perform photoselective vaporization of the prostate PVP has been widely accepted as a safe and effective treatment for benign prostatic hyperplasia with very few reported complications.
Case report A previously healthy year-old man presented for treatment of his symptomatic benign prostatic hyperplasia BPH. Open in a separate window. Conclusion This case report demonstrates a number of important issues. Footnotes Competing interests: None declared. References 1. A randomized trial of photoselective vaporization of the prostate using the W potassium-titanyl-phosphate laser vs transurethral prostatectomy, with a 1-year follow-up. BJU Int. Photoselective vaporization PVP versus transurethral resection of the prostate TURP : a prospective bi-center study of peri-operative morbidity and early functional outcome.
Eur Urol. Comparison of potassium-titanyl-phosphate laser vaporization of the prostate and transurethral resection of the prostate: update of a prospective nonrandomized two-centre study.
Green Light photoselective watt nm lithium triborate laser vaporization prostatectomy in living canines. J Endourol. Reich O. Greenlight: Vaporisation der Prostata in Kirov potassium-titanyl-phosphate to lithium triborate or from good to better? Curr Opin Urol. High performance system GreenLight laser: indications and outcomes. Current Opin Urol. GreenLight HPS W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up.