LASER BLADDER NECK INCISION: SMALL FIBROTIC PROSTATE WITH BLADDER OUTLET OBSTRUCTION

A 60 year old gentleman came with complaints of weak stream,frequency,nocturia over a period of 1 year.He was tried on alpha blockers before but didnot respond.He was a known case of asthma in remission not on any brochodilators.His ultrasound has shown 20 cc prostate with 90 cc post-void residual urine and increased bladder wall thickness(6 mm).

His PSA was 1.77 ng/ml,urine culture was sterile and other hematological and biochemical parameters were normal.His uroflowmetry showed obstructive pattern.He was taken up for LASER BNI surgery.The bladder showed grade 2 trabeculations with high bladder neck.The prostate and the anterior urethra was grossly normal.The Bladder neck incision was carried out with continuous wave Thulium laser ( 2 micron) with 70 w power.The incision was carried out from the level of ureteric orifices till the level of verumontanum reaching to the depths of the capsule.At the end of the procedure the bladder neck region was widely open as seen with stopping the irrigation.The hemostasis was achieved and 18 Fr foleys catheter ( a 2 -way catheter) with no traction and irrigation.The plan is to remove catheter after 24 hours and give him a catheter free trial.