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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

5,040 subscribers

29,294 Aufrufe • vor 3 Monaten •via X (Twitter)

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16 Kommentare

Profilbild von sultan sultan

sultan sultanvor 3 Monaten

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.

Profilbild von DR CARVAJAL

DR CARVAJALvor 3 Monaten

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.

Profilbild von Francisco

Franciscovor 3 Monaten

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

Profilbild von DR CARVAJAL

DR CARVAJALvor 3 Monaten

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

Profilbild von collacamba

collacambavor 3 Monaten

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

Profilbild von DR CARVAJAL

DR CARVAJALvor 3 Monaten

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.

Profilbild von KC Safi

KC Safivor 3 Monaten

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

Profilbild von DR CARVAJAL

DR CARVAJALvor 3 Monaten

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

Profilbild von miguel angel bergero

miguel angel bergerovor 3 Monaten

Láser setting?

Profilbild von DR CARVAJAL

DR CARVAJALvor 3 Monaten

72/48 W 1.8 x 40

Profilbild von Chris Haas

Chris Haasvor 3 Monaten

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

Profilbild von DR CARVAJAL

DR CARVAJALvor 3 Monaten

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

Profilbild von Dra.Cristina Navarro | Urología

Dra.Cristina Navarro | Urologíavor 3 Monaten

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

Profilbild von Balaji Kalyanaraman

Balaji Kalyanaramanvor 3 Monaten

What are the longer term outcomes for stricture?

Profilbild von DR CARVAJAL

DR CARVAJALvor 3 Monaten

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.

Profilbild von Jarurat_Care

Jarurat_Carevor 3 Monaten

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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