Korean J Urol.  2015 Feb;56(2):150-156. 10.4111/kju.2015.56.2.150.

Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses

• Lee CH
• Ku JY
• Park YJ
• Lee JZ
• Shin DG

• KMID: 2133280
• DOI: http://doi.org/10.4111/kju.2015.56.2.150

Abstract

PURPOSE
Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses.
MATERIALS AND METHODS
From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed.
RESULTS
Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient.
CONCLUSIONS
Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.

Keyword

Abscess; Holmium; Prostate; Transurethral resection of prostate

MeSH Terms

Abscess/etiology/radiography/*surgery
Aged
Aged, 80 and over
Calcinosis/complications/surgery
Drainage/methods
Holmium
Humans
Lasers, Solid-State/*therapeutic use
Male
Middle Aged
Prostatic Diseases/etiology/radiography/*surgery
Retrospective Studies
Tomography, X-Ray Computed
Transurethral Resection of Prostate/*methods
Treatment Outcome
Urinary Bladder Neck Obstruction/complications/surgery
Holmium

Figure

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  Fig. 1 Intraoperative images. (A) As the abscess cavity was opened up, the pus was drained from the cavity. The pus in the abscess cavity was washed out with continuous normal saline irrigation. (B) Small prostatic calcifications in the abscess cavity. Scan this QR code to see the accompanying video, or visit www.kjurology.org or http://youtu.be/zSq-kk7dQ_E.

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  Fig. 2 Preoperative and postoperative computed tomography (CT) scans of a patient. (A) Preoperative CT scan showing multiloculated prostatic abscesses. (B) Postoperative CT scan, which was performed at 2 weeks after surgery, showing a markedly reduced multiloculated abscess cavity.

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  Fig. 3 Transrectal ultrasound (TRUS) image and intraoperative image. (A) TRUS image showing that the abscess cavity (asterisk) is located between the prostate adenoma and the prostate capsule. (B) Intraoperative image showing that the opening of the prostate abscess (arrow) is located below the prostate adenoma (asterisk).

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