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Small prostates can cause significant bladder damage too—and when an unsuspected urethral stricture is added to the equation, #HoLEP with miniature instruments (#MiLEP) becomes an excellent solution. 💡 The technique is exactly the same: despite the increased fibrosis and limited glandular tissue, the dissection plane is usually easy to... show more

DR CARVAJAL

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29,294 次观看 • 3 个月前 •via X (Twitter)

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16 条评论

sultan sultan 的头像

sultan sultan3 个月前

There is a stricture of the urethra which is mostly the cause of bladder trabeculae and diverticulae. I think it is preferable to defer prostate surgery.

DR CARVAJAL 的头像

DR CARVAJAL3 个月前

Sultan, that’s a great point. However, if you look closely, he also has a high, sclerotic bladder neck. Simply treating the stricture alone would probably not have fully improved his urinary flow or bladder emptying.

Francisco 的头像

Francisco3 个月前

Pero no sería la estenosis de uretra la que tenía dañada la vejiga?

DR CARVAJAL 的头像

DR CARVAJAL3 个月前

Es probable Francisco, aunque su sintomatología es anterior al único antecedente que tiene de probable lesión a la uretra (colocación de SF)

collacamba 的头像

collacamba3 个月前

Wouldn’t it be better to perform a simple prostatotomy?

DR CARVAJAL 的头像

DR CARVAJAL3 个月前

Yes, that’s an option, but I feel that enucleation is a more comprehensive and longer-lasting solution. It also provides tissue that can be analyzed.

KC Safi 的头像

KC Safi3 个月前

In such high urethral angle small prostate, Do we rally need full enucleation? Or just the middle part?

DR CARVAJAL 的头像

DR CARVAJAL3 个月前

Safi, It’s the same tissue. If you find the right plane, you can remove it in one piece, which reduces the chances of it growing back

miguel angel bergero 的头像

miguel angel bergero3 个月前

Láser setting?

DR CARVAJAL 的头像

DR CARVAJAL3 个月前

72/48 W 1.8 x 40

Chris Haas 的头像

Chris Haas3 个月前

Any tips for reducing risk of bladder neck contracture after HoLEP of small <30gm glands? Longer catheter duration?

DR CARVAJAL 的头像

DR CARVAJAL3 个月前

Use low energy, preserve the bladder neck, avoid coagulation at the end if possible, and inject triamcinolone

Dra.Cristina Navarro | Urología 的头像

Dra.Cristina Navarro | Urología3 个月前

The MiLEP approach in small fibrotic prostates is a good reminder that gland size doesn’t predict symptom severity. Some of the most obstructed patients I’ve seen had prostates under 30cc. Trusting the dissection plane despite the fibrosis is exactly the right mindset

Balaji Kalyanaraman 的头像

Balaji Kalyanaraman3 个月前

What are the longer term outcomes for stricture?

DR CARVAJAL 的头像

DR CARVAJAL3 个月前

I’m not sure, Balaji. It seems to be annular and is unlikely to recur, but if it does, I’d start considering treatment with a paclitaxel-coated balloon.

Jarurat_Care 的头像

Jarurat_Care3 个月前

Hi Dr. Carvajal, Join us for a free Zoom session on Gastric & Gastroesophageal Cancers, 27 Jun, 5:00 PM IST. Featuring experts from Weill Cornell & MD Anderson, with case based discussions and global panelists. Register:

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Why do I almost always choose 22Fr for #MiLEP? Because you simply don’t need a larger caliber. Excellent visualization, smoother freedom of movement, and less urethral stress throughout the procedure. And if you unexpectedly encounter a urethral stricture, you can perform a direct-vision urethrotomy with the same equipment, adding virtually no operative time and avoiding unnecessary urethral trauma. Don’t fear morcellation with 22Fr. With meticulous hemostasis, visibility is excellent for safe, fast, and efficient morcellation. And for value and performance, the #Hawk morcellator continues to impress me. 22Fr. One setup. Less urethral stress. No compromise. #MiLEP #Endourology #BPH #Urology Ako Medical Support #HoLEP

Why do I almost always choose 22Fr for #MiLEP? Because you simply don’t need a larger caliber. Excellent visualization, smoother freedom of movement, and less urethral stress throughout the procedure. And if you unexpectedly encounter a urethral stricture, you can perform a direct-vision urethrotomy with the same equipment, adding virtually no operative time and avoiding unnecessary urethral trauma. Don’t fear morcellation with 22Fr. With meticulous hemostasis, visibility is excellent for safe, fast, and efficient morcellation. And for value and performance, the #Hawk morcellator continues to impress me. 22Fr. One setup. Less urethral stress. No compromise. #MiLEP #Endourology #BPH #Urology Ako Medical Support #HoLEP

DR CARVAJAL

25,191 次观看 • 1 个月前

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130,566 次观看 • 5 个月前

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36,973 次观看 • 7 个月前

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91,033 次观看 • 1 个月前

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