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... identify—you just have to trust it and follow it step by step without skipping any part of the procedure. The best part? In experienced hands, you can be done in about 20 minutes. 😎 #Urology #HoLEP #MiLEP #Endourology #ProstateEnucleationshow more

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.

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.

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

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

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

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.

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

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

Láser setting?

72/48 W 1.8 x 40

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

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

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

What are the longer term outcomes for stricture?

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.

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