A Gentleman aged 95 yrs presented to our emergency room with urinary retention for last 6hrs.He was immediately catheterised under strict aseptic precautions by our expert urologist and admitted for further evaluation and management.
The basic work up includes prostate diagnostic package and general cardio-respiratory screening to detect any other ailments possible at that age.He was put on appropriate antibiotic cover and after all investigations revealed his condition fit for the laser prostate surgery,the risk stratification was done by our intensivist,cardiologist and anaesthesiologist.
He had a prostate of 50gm size and counselled for laser prostatectomy with mild-moderate risk in view of age.He was shifted to OT and given spinal anaesthesia and made to settle in sitting position for 2 min to minimise the risks of cephalic spread of spinal anaesthesia.He was then put in lithotomy position and laser prostaectomy started using thulium laser with 70w as starting power for prostate vaporisation and enucleation was done at 30 w power.All the 3 lobes were enucleated succesfully without any bleeding.
The lobes were then morcellated with wolf morcellator and 2 way 20f catheter inserted.Normal saline was used as irrigation fluid throughout the procedure and this leaves no chance of any neurological complications seen with glycine used at the time of conventional TURP.
The patient was then shifted to post op care unit where he was monitored for 8 hrs before shifted to room to be with relatives.He was ambulated and after good recovery discharged on 3rd day without catheter.
With more technological advancements,it is possible to improve the quality of life irrespective of age.This happens at ramayya pramila often as we are in pursuit of perfection ALL THE TIME.