Calculi in the Prostatic Surgical Bed as a complication after Holmium Laser Enucleation of the Prostate

Area of Science:

• Urology
• Surgical Complications
• Nephrolithiasis

Background:

• Holmium laser enucleation of the prostate (HoLEP) is a common treatment for benign prostatic hyperplasia (BPH).
• While generally safe, surgical complications can occur, necessitating thorough post-operative monitoring.
• De novo stone formation in the prostatic surgical bed is an underreported complication.

Purpose of the Study:

• To report the occurrence of de novo calculi in the prostatic surgical bed following HoLEP.
• To describe the clinical presentation, diagnostic methods, and pathological findings associated with this rare complication.

Main Methods:

• A retrospective review of patients who underwent HoLEP and were part of a BPH Database Registry (July 2008 - December 2015).
• Identification of cases requiring calculi removal from the prostatic surgical bed.
• Collection and description of clinical data, including symptoms, urinalysis, pathology, cystourethroscopy, and stone analysis.

Main Results:

• Seven out of 877 patients (0.8%) developed calculi in the prostatic surgical bed after HoLEP.
• The median age was 67 years, with a median prostatic volume of 75.5 mL.
• The most frequent symptom was severe urethral pain, occurring a median of 13 months post-surgery. Stones were often pedunculated with a mucosal connection. Pathology revealed granulation tissue and dystrophic calcification.

Conclusions:

• De novo calculi in the prostatic surgical bed or bladder neck after HoLEP are previously unreported.
• Recurrent urethral pain, persistent pyuria, or gross hematuria warrant investigation for potential stone presence.
• Cystourethroscopy and a high index of suspicion are crucial for diagnosing these rare post-HoLEP calculi.