Need for upper urinary tract stenting in cases of ureteral orifice injury during laser enucleation of the prostate

Benign prostatic hyperplasia (BPH) can be associated with marked intravesical protrusion, placing ureteral orifices at risk for injury during bladder outlet procedures.

To determine whether ureteral stenting is necessary in cases of ureteral orifice injury during laser enucleation.

Retrospective study included 465 patients with bladder outlet obstruction (IPSS > 20, Qmax < 10) secondary to BPH who were managed with thulium fiber laser (ThuFLEP) or holmium laser enucleation of the prostate (HoLEP). In seven patients, the ureteral orifices were injured during surgery (3-HoLEP; 4-ThuFLEP). Three of the seven patients underwent intraoperative stenting of the upper urinary tract (1-HoLEP; 2-ThuFLEP). In four cases, stenting was not performed (2-HoLEP; 2-ThuFLEP). The follow-up period was 6 months.

Postoperatively, none of the patients with a stent in the upper urinary tract exhibited signs of pelvicalyceal system (PCS) dilatation or inhibited urine flow from the kidney (assessed with abdominal ultrasound at 1, 3, 10, and 30 days after surgery). In two patients without stents, follow-up revealed no dilatation of the PCS. The other two patients without stents developed asymptomatic dilatation of the PCS (the pelvis-up to 1.5 cm; the calyx-up to 0.5 cm). At 1 month after surgery, no patients had dilatation of the PCS.

Upper urinary tract stenting in cases of intraoperative ureteral orifice injury during laser enucleation of the prostate for BPH may not be warranted.

International urology and nephrology. 2018 Oct 22 [Epub ahead of print]

Dmitry Enikeev, Petr Glybochko, Leonid Rapoport, Olesya Snurnitsyna, Natalia Potoldykova, Tamara Novoselova, Ekaterina Laukhtina, Mark Taratkin, Vitaly Margulis

Research Institute for Uronephrology and Reproductive Health, Sechenov University, Bolshaya Pirogovskaya st, 2-1, Moscow, Russia, 119991. ., Research Institute for Uronephrology and Reproductive Health, Sechenov University, Bolshaya Pirogovskaya st, 2-1, Moscow, Russia, 119991., Department of Medical Statistic, Sechenov University, Moscow, Russia., Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.

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