Ho:YAG-laser: treatment of vesicourethral strictures after radical prostatectomy

Refractory Bladder Neck Contracture (BNC) After Radical Prostatectomy: Prevalence, Impact and Management Challenges

Bladder neck contracture is a recognised complication associated with radical prostatectomy. The management can be challenging, especially when refractory to initial intervention strategies. For the patient, the burden of disease is high and continence status cannot be overlooked. This review serves to provide an overview of the management of this recognised clinical pathology. Consideration needs to be given to minimally invasive approaches such as endoscopic incision, injectables, implantable devices as well as major reconstructive surgery where the condition persists. For the latter, this can involve open and robotic surgery as well as use of grafts and artificial sphincter surgery. These elements underline the need for a tailored and a patient centred approach.

Trans-Sacral Epiduroscopic Laser Decompression for Symptomatic Lumbar Disc Herniation: A Preliminary Case Series

OBJECTIVE

The purpose of this study was to investigate the effect of trans-sacral epiduroscopic laser decompression (SELD) in patients with a herniated lumbar disc.

METHODS

This prospective case series study was designed to determine the outcomes of SELD with regard to reducing pain and improving the functional status in patients with low back pain (LBP) and radiculopathy caused by definitive neural compression confirmed by MRI. A total of 250 patients with LBP and simultaneous radiculopathy underwent SELD by applying a Ho:YAG laser. Clinical outcomes were evaluated using the visual analogue scale (VAS) score for LBP, and radiculopathy and functional status were measured using the Oswestry Disability Index (ODI).

RESULTS

At 2 weeks after the procedure, the average VAS score for leg pain decreased to 3.6 from 7.1 (p < 0.01), and the average VAS score for back pain decreased to 4.1 from 5.9 (p < 0.01). At 3 months, the average VAS scores for leg and back pain decreased to 2.6 and 2.7, respectively. The mean ODI improved from 50 to 19 at 2 weeks postoperatively and further decreased to 12 at 3 months postoperatively.

CONCLUSIONS

The VAS score and ODI significantly improved after SELD in herniated nucleus pulposus (HNP) patients with LBP and radiculopathy. Postoperative MRI showed a notable decrease in the HNP size and a reduction in neural compression. SELD is suggested to be an effective therapeutic modality for patients with symptomatic HNP.

Bipolar plasma vaporization versus standard transurethral resection in secondary bladder neck sclerosis: a prospective, medium-term, randomized comparison

OBJECTIVES

This prospective, randomized, medium-term trial aimed to assess the efficiency, safety and postoperative results of bipolar plasma vaporization (BPV) in comparison with monopolar transurethral resection (TUR) in cases of secondary bladder neck sclerosis (BNS).

METHODS

A total of 70 patients with BNS secondary to transurethral resection of the prostate (TURP; 46 cases), open prostatectomy for benign prostatic hypertrophy (BPH; 18 cases) and radical prostatectomy for prostate cancer (6 cases) were enrolled in the trial. The inclusion criteria consisted of maximum flow rate (Q max) <10 ml/s and International Prostate Symptom Score (IPSS) >19. All patients were evaluated preoperatively and at 1, 3, 6, 12 and 18 months after surgery by IPSS, quality of life score (QoL), Q max and postvoiding residual urinary volume (PVR).

RESULTS

The mean operation time (10.3 versus 14.9 minutes), catheterization period (0.75 versus 2.1 days) and hospital stay (1.1 versus 3.2 days) were significantly reduced in the BPV series. During the immediate postoperative follow up, recatheterization for acute urinary retention only occurred in the TUR series (5.7%). The medium-term retreatment requirements due to BNS recurrence were lower in the BPV study arm (2.8% versus 8.5%). At the 1, 3, 6, 12 and 18 months assessments, statistically similar parameters were found concerning the IPSS and QoL symptom scores, Q max and PVR values specific for the two therapeutic alternatives.

CONCLUSIONS

BPV constitutes a valuable endoscopic treatment approach for secondary BNS. The method emphasized superior efficacy, a satisfactory safety profile and similar medium-term follow-up features when compared with standard TUR.

Recurrent urethrovesical anastomotic strictures following artificial urinary sphincter implantation: a case report

INTRODUCTION

The management of an anastomotic stricture after a radical prostatectomy can become a complex and difficult situation when an artificial urinary sphincter precedes the formation of the stricture. The urethral narrowing does not allow the passage of the routinely used urological instruments and no previous reports have suggested alternate approaches.

CASE PRESENTATION

We present the case of a 68-year-old Greek man diagnosed as having a recurrent anastomotic stricture approximately two years after a radical prostatectomy and three years after the implantation of an artificial urinary sphincter, and propose novel alternate methods of treatment. Our patient was first subjected to stricture incision with the use of a rigid ureteroscope with a holmium:yttrium-aluminium-garnet laser fiber, which was followed by a second successful attempt with the use of a pediatric resectoscope. After a one-year follow-up, our patient is doing well, with no evidence of recurrence.

CONCLUSIONS

To the best of our knowledge, this is the first report of the management of recurrent urethral strictures following an artificial urinary sphincter implantation. Minimal invasive techniques with the use of small caliber instruments may offer efficient treatment options, diminishing the danger of urethral corrosion.

[Urothelial carcinoma of the bladder: evaluation by combined endoscopy and urine cytology: is incontrovertible assessment possible?]

BACKGROUND

Transurethral resection of transitional cell carcinoma of the bladder provides a definitive surgical treatment and supplies tissue for histological evaluation. Superficial low-grade carcinomas with a small risk of progression are treated properly with fulguration alone. To justify fulguration as a definitive treatment of papillary bladder tumours, one must be able to safely distinguish low-grade, noninvasive tumours from those that are high grade and potentially invasive.

MATERIAL AND METHODS

A total of 160 patients with a transitional cell carcinoma at cystoscopy underwent transurethral resection of the tumour. The macroscopic appearance of the tumour, the aspect with bimanual palpation and the perioperative urine cytology were compared with the histological report.

RESULTS

In our study we were able to safely distinguish low-grade tumours from high-grade tumours. All noninvasive tumours could be identified visually as such.

CONCLUSION

Urologists skilled in the evaluation of urine cytology can distinguish low-grade noninvasive tumours of the bladder from high-grade and potentially invasive tumours by means of appearance at cystoscopy and perioperative urine cytology.

The evolution of lasers in urology

The world's first laser was developed by Theodore Maiman in 1960. Over the course of the past five decades, this technology has evolved into a highly specialized entity, also finding a niche market in the field of urology. Lasers obtained from various lasing mediums producing amplified light of different wavelengths have been tested for urological applications. Today, these lasers are most commonly used in the surgical management of benign prostatic hyperplasia and as intracorporeal lithotripters. Other uses include ablation of various urologic tumors and incising strictures of the upper- and lower urinary tract. A continuous process of evolution of this technology is taking place, resulting in surgical lasers becoming ever safer, more effective, and more affordable.