Research fellow Baylor Scott & White Health; Alexandria University Faculty of Medicine, Egypt
Introduction: There is a recent increasing interest in focal gland ablation for localized prostate cancer. The major advantage of focal therapy over whole gland treatment is reduction of urinary and sexual complications. However, there is still lack of high-quality evidence on long-term oncological outcome. Methods: We present a case of 71 years old patient presented by hematuria and urine retention 3 weeks post-focal laser ablation of prostate cancer. The patient had enlarged prostate of 145 grams with large median lobe and Gleason score 4+3 prostate cancer. Results: Cystoscopy revealed multiple areas of necrosis especially on the right lateral lobe and involving the ejaculatory ducts with possible extra-capsular necrosis extending to the seminal vesicles. HoLEP was deliberately performed as shown in the video. There were multiple areas of necrosis at the level of the capsule of the prostate that were formed by the focal laser ablation. At the end of the procedure, cystogram was done and methylene blue was injected inside the bladder with rectal exam to exclude connection between the prostatic urethra and the rectum. Conclusions: Multi-disciplinary approach is crucial for proper selection of the patients for focal therapy. Although data reports minimal complications with focal laser ablation of prostate cancer, significant urinary complications can be anticipated especially with large prostate volume. HoLEP is an effective option for management of urinary complications of focal therapy. SOURCE OF Funding: None
