|
1
|
Fujishima Y, Furuta A, Kawamura T, Machida A, Igarashi T, Maekawa S, Kato R, Kanehira M, Kimura T, Obara W. Two cases of pelvic hematoma after prostatic urethral lift surgery. IJU Case Rep 2024; 7:26-29. [PMID: 38173460 PMCID: PMC10758907 DOI: 10.1002/iju5.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction There are few reports of pelvic hematoma after prostatic urethral lift. Here, we report two cases of pelvic hematoma in Japan. Case presentation The first case was a 71-year-old man with benign prostatic hyperplasia who underwent prostatic urethral lift. Although the procedure was uneventful, he experienced lower abdominal pain the day after the operation. CT revealed a hematoma in the right pelvis; however, it was manageable with conservative treatment. The second case was a 68-year-old man. The procedure was uneventful; however, 6 days after the operation, a subcutaneous hematoma appeared in the lower abdomen. CT revealed a hematoma in the left pelvis. We then performed pelvic hematoma removal surgery. Conclusions Pelvic hematomas after PUL may requires attention, particularly in men with the narrow pelvises. Appropriate compression of the prostate and a high lithotomy position procedure could effectively avoid the occurrence of pelvic hematomas.
Collapse
Affiliation(s)
- Yosuke Fujishima
- Department of UrologyIwate Prefectural Iwai HospitalIchinosekiJapan
- Department of UrologyIwate Medical UniversityMoriokaJapan
| | - Akira Furuta
- Department of UrologyJikei University School of MedicineTokyoJapan
| | - Tatsuya Kawamura
- Department of UrologyIwate Prefectural Iwai HospitalIchinosekiJapan
| | - Arisa Machida
- Department of UrologyIwate Prefectural Iwai HospitalIchinosekiJapan
| | - Taro Igarashi
- Department of UrologyJikei University School of MedicineTokyoJapan
| | | | - Renpei Kato
- Department of UrologyIwate Medical UniversityMoriokaJapan
| | | | - Takahiro Kimura
- Department of UrologyJikei University School of MedicineTokyoJapan
| | - Wataru Obara
- Department of UrologyIwate Medical UniversityMoriokaJapan
| |
Collapse
|
|
2
|
Leonardi R, Ambrosini F, Malinaric R, Cafarelli A, Calarco A, Colombo R, De Cobelli O, De Marco F, Ferrari G, Ludovico G, Pecoraro S, Tuzzolo D, Terrone C, Mantica G. New minimally invasive solutions for Benign Prostatic Obstruction (BPO) management: A position paper from the UrOP (Urologi Ospedalità Gestione Privata). Arch Ital Urol Androl 2023; 95:12003. [PMID: 38117214 DOI: 10.4081/aiua.2023.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
To the Editor, In recent years, alternative solutions have been proposed to obtain effective results comparable to TURP, which is currently considered the gold standard, and laser vapo-enucleation techniques (1, 2), but with the possibility of maintaining sexual functions. In recent years there has been a growing trend towards ejaculation preservation. Although the results of TURP (3), and most laser enucleation techniques are undoubted in the Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) management, they often lack in the preservation of ejaculation. All the alternative recently proposed interventions (Rezum, AquaBeam, Urolift, TPLA, i-TIND, LEST) are procedures considered by some authors to be promising in both managing BPO and preserving sexual functions. However, all these methods are limited by a lack of long-term follow-up that would evaluate the efficacy over time, possible complications related to the method and the correct patient selection for a specific method. The aim of this letter is to summarize the available evidence and provide clinicians with practical recommendations on the use of the brand new minimally invasive techniques for the management of BPO. [...].
Collapse
Affiliation(s)
- Rosario Leonardi
- Urologi Ospedalità Gestione Privata (UrOP); Casa di Cura Musumeci GECAS, Gravina di Catania.
| | | | | | - Angelo Cafarelli
- Urologi Ospedalità Gestione Privata (UrOP); Urology Unit, Villa Igea, Ancona.
| | - Alessandro Calarco
- Urologi Ospedalità Gestione Privata (UrOP); Villa Pia Hospital, Via Folco Portinari 5, Rome.
| | - Renzo Colombo
- Urologi Ospedalità Gestione Privata (UrOP); Department of Urology, Vita e Salute San Raffaele University, Milan.
| | - Ottavio De Cobelli
- Urologi Ospedalità Gestione Privata (UrOP); Department of Urology, IEO European Institute of Oncology, IRCCS, Milan.
| | | | - Giovanni Ferrari
- Urologi Ospedalità Gestione Privata (UrOP); Hesperia Hospital, Modena.
| | - Giuseppe Ludovico
- Urologi Ospedalità Gestione Privata (UrOP); Ospedale Miulli, Acquaviva delle Fonti, Bari.
| | | | | | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
| | - Guglielmo Mantica
- Urologi Ospedalità Gestione Privata (UrOP); IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
| |
Collapse
|
|
3
|
Juliebø-Jones P, Somani BK, Tzelves L, Haugland JN, Moen CA, Honoré A, Beisland C. Complications and device failures associated with urolift: Findings from the MAUDE database. Urologia 2023; 90:636-641. [PMID: 37292024 PMCID: PMC10623594 DOI: 10.1177/03915603231180016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Urolift is an established intervention for symptoms of bladder outflow obstruction caused by benign prostate enlargement. Reported advantages include its minimally invasive profile, short learning curve and feasibility as a day case procedure. Our aim was to use a national registry as a means to evaluate the nature of complications and device failures that have been documented to occur. METHODS Retrospective review was performed of the US Manufacturer and User Facility Device Experience (MAUDE) database, a prospective register, which contains voluntarily submitted adverse events associated with surgical devices. Information collected include event timing, underlying cause, procedural completion, complications and mortality status. RESULTS Between 2016 and 2023, 103 device failures, 5 intra-operative complications and 165 post-operative complications (early: 151, late: 14) were registered. The commonest device problem (56%, n = 58) was failure of the implant to deploy with subsequent requirement for complete replacement. There were 50 cases of documented urosepsis. 62 patients with post operative haematuria were registered including 12 that underwent emergency embolisation. Other complications included stroke (n = 5), pulmonary embolism (n = 3) and necrotising fasciitis (n = 1). Twelve ITU admissions were registered. In the reports, 22 cases were filed that recorded a hospital stay of 7 days or more. Eleven deaths were captured in the database over the study period. CONCLUSION While urolift is recognised as less invasive intervention compared to alternatives such as transurethral resection of the prostate, serious adverse events have been reported to occur including death. Our findings can provide learning points for surgeons and allow for improved patient counselling and treatment planning accordingly.
Collapse
Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | | | | | - Alfred Honoré
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
|
4
|
Bozkurt AS, Ekici O, Keskin E, Kocoglu F. Bladder stone due to late clip migration after prostatic urethral lift procedure: A case report. World J Clin Cases 2023; 11:7457-7462. [PMID: 37969453 PMCID: PMC10643076 DOI: 10.12998/wjcc.v11.i30.7457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/05/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Prostatic urethral lift (PUL) therapy is an alternative to minimally invasive and other surgeries in younger patients who want to preserve their sexual and ejaculatory functions, and in elderly male patients with benign prostatic hyperplasia who cannot be anesthetized because of the risk of anesthesia. The procedure can be performed as an outpatient and without anesthesia, and complications are few and temporary. In long-term follow-up, encrustations that require retreatment are rarely seen. CASE SUMMARY In our case, a 62-year-old prostate patient who had a PUL operation 8 years ago and had a stone on the PUL material near the bladder neck was treated. The patient's stone was removed by endoscopic cystolithotripsy using pneumatic fragmentation. Bipolar transurethral resection of the prostate was applied to the patient in the same session. After the patient's 7-year follow-up, the patient's complaints relapsed, and cystoscopy was performed again. In cystoscopy, stone formation adjacent to the wall was observed at the junction of the bladder neck to the left lateral wall. The stone was fragmented with a pneumatic lithotripter. CONCLUSION Placing clips too close to bladder neck in the PUL procedure may result in clip migration.
Collapse
Affiliation(s)
- Ali Seydi Bozkurt
- Department of Urology, Erzincan Binali Yıldırım University School of Medicine, Erzincan 24000, Turkey
| | - Ozgur Ekici
- Department of Urology, Erzincan Binali Yıldırım University School of Medicine, Erzincan 24000, Turkey
| | - Ercüment Keskin
- Department of Urology, Erzincan Binali Yıldırım University School of Medicine, Erzincan 24000, Turkey
| | - Fatih Kocoglu
- Department of Urology, Erzincan Binali Yıldırım University School of Medicine, Erzincan 24000, Turkey
| |
Collapse
|
|
5
|
Ho BSH, Tsu JH. Angioembolization for massive pelvic hematoma after prostatic urethral lift. IJU Case Rep 2023; 6:219-221. [PMID: 37405029 PMCID: PMC10315246 DOI: 10.1002/iju5.12590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/02/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Pelvic hematomas are a rare complication of prostatic urethral lift. We would like to report the first case of massive pelvic hematoma after prostatic urethral lift that was successfully managed by selective angioembolization. Case presentation An 83-year-old gentleman with benign prostatic hyperplasia underwent prostatic urethral lift. Although the procedure was uneventful, he developed shock while in the recovery room. Urgent contrast computed tomography scan showed a large heterogenous hematoma at the right pelvis extending to the right retroperitoneum with contrast extravasation noted. Urgent angiogram confirmed extravasation from the right prostatic artery. Angioembolization with coils and 33% N-butyl cyanoacrylate glue was successfully performed. Conclusion Prostatic urethral lift can be complicated by the rare massive pelvic hematoma, possibly more common in small prostates. With a prompt contrast computed tomography scan, pelvic hematomas can be managed with angioembolization first and hopefully prevent open exploratory surgery.
Collapse
Affiliation(s)
- Brian Sze Ho Ho
- Division of Urology, Department of SurgeryQueen Mary HospitalHong Kong
| | | |
Collapse
|
|
6
|
Rodríguez-Fernández LF, Bernaschina-Bobadilla CP. Pelvic Hematoma After UroLift: A Case Report and Literature Review. Cureus 2023; 15:e38193. [PMID: 37252539 PMCID: PMC10223866 DOI: 10.7759/cureus.38193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
UroLift is a novel, minimally invasive surgical technique used to treat bladder outlet obstruction due to benign prostatic hyperplasia (BPH). UroLift was granted US FDA approval in 2013, and so far, it has gained acceptance and popularity worldwide. In this case report, we present a 69-year-old male patient that developed a pelvic hematoma with subacute clinical manifestations two months following UroLift. The patient was managed conservatively, resulting in the complete resolution of the hematoma. As more surgeons are trained, and the caseload increases, we expect to see more complications related to this novel technique. Surgeons should be aware of this procedure's potential short- and long-term complications.
Collapse
|
|
7
|
Large Pelvic Hematoma after UroLift® Procedure for Treatment of BPH with Median Lobe. Case Rep Urol 2022; 2022:7065865. [PMID: 35340677 PMCID: PMC8942674 DOI: 10.1155/2022/7065865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
The UroLift® procedure is a minimally invasive technique used to treat benign prostatic hyperplasia (BPH) in the office or hospital setting. As of 2021, over 200,000 of these procedures have been performed, with an excellent safety profile. We present a case report of a patient who underwent the UroLift® procedure and was found to have a 16.5 cm pelvic hematoma within 16 hours. This study was done as a retrospective chart review. In addition, a comprehensive review of the literature was performed, and all relevant government and company websites were reviewed for thorough evaluation. The patient had an uncomplicated inpatient UroLift® procedure for BPH using 5 implants and was discharged from the hospital without incident. The patient presented to the emergency department with abdominal pain 16 hours after the procedure, and a 16.5 cm pelvic hematoma was found on computerized tomography (CT) scan. Since 2015, there have been 27 cases of pelvic hematoma after UroLift® reported to the United States Food and Drug Administration (FDA), and only 2 cases published in the literature. Our patient required hospital admission for 3 days and 3 units of packed red blood cells, but no surgical exploration or intervention. The procedure was technically successful as it improved the patient's voiding and lower urinary tract symptoms (LUTS) as of 2-month follow-up. Potential etiologies include implant firing depth beyond the extent of the prostate, as well as treatment of the median lobe.
Collapse
|
|
8
|
Bladder stone secondary to prostatic urethral lift (PUL) for benign prostatic hyperplasia (BPH). Urol Case Rep 2021; 39:101777. [PMID: 34345589 PMCID: PMC8319443 DOI: 10.1016/j.eucr.2021.101777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
Unlike other cavitating prostatic surgeries, prostatic urethral lift (PUL) has the advantage of being noninvasive and having fewer complications. In addition, PUL can be performed under local anesthesia and is can be performed on patients with various comorbidities. However, serious complications have been reported in some patients, so caution is required. We describe a Case of a bladder stone as a complication after PUL surgery. To our knowledge, large bladder stone following prostatic urethral lift (PUL) is a unique complication not previously described in the literature.
Collapse
|