Wednesday, February 17, 2010

LASER prostatectomy in high risk old patient

A 90 year old gentleman presented to us with refractory retention and overflow incontinence. He had history of chronic subdural hematoma which was drained in the month of January 2010.On evaluation, he had grade 3 prostatomegaly.The Ultrasound examination revelaed 96 gm prostate and bilateral hydroureteronephrosis. Renal Function Tests revelaed mildly lelevated creatinine levels(1.8 mg%).
After initial stabilisation of creatinine with indwelling catheter(after subsidence of the bilateral hydro-ureteronephrosis) he was taken for LASER Prostatectomy.He was cleared by physician with moderate risk because of sub-optimal (45%)ejection fraction.

The Prostatectomy was done with Continuous wave Thulium Laser and took 40 minutes for the enucleation.The procedure was completed with morcellation.A 18-Fr Foleys catheter was kept in the bladder.The catheter was removed the very next day and the patient was discharged.The patient is voiding well with good amount void.
The Thulium LASER causes fast and clean cut without vibration because of continuous wave Technology.It causes rapid vaporization of both glandular and fibrous prostate.As the Laser is absorbed by cellular water –it is useful for both fibrous and glandular prostate.The depth of penetration of the Laser therefore is shallow and there is minimal chance of secondary hemorrhages as there is no necrotic tissue in the prostatic bed.This technology is very safe and effective in vessel sealing of both arteries and veins.

We used Richard Wolf 22.5 F Continuous Flow Scope so the rate of the urethral stricture is comparitively less than the other endoscopic methods.
This technology can be offered to old frail patients with cardiac risk and even on anticoagulants and platelet aggregate inhibitors.

Thulium LASER machine

Procedure being carried out

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