Dr. Dean on opening up the bladder neck during HoLEP

In this video, Nicholas S. Dean, MD, highlights take-home messages based on findings from the study, “Short-Term Clinical Outcomes of Bladder Neck Incision at Time of Holmium Laser Enucleation of the Prostate,” for which he served as the lead author. Dean is an endourology fellow at Northwestern University in Chicago, Illinois.

Video Transcript:

The big take-home point from this study is that the rate of bladder neck contracture is very low at 0.5% at 14 months follow-up. This is using contemporary techniques and technology, which might have led to that lower rate than prior retrospective cohort studies. It is also reassuring that in our prophylactic bladder neck incision cohort, who had a lower preoperative prostate volume, who you'd expect would be at increased risk of bladder neck contractures, they had a 0% bladder neck contracture rate, which is also very reassuring. That will encourage us to continue to offer bladder neck incision to these patients if their bladder neck appears narrow after laser enucleation.

There's a growing trend that we've observed in robotic simple prostatectomy where in an attempt to get patients home on the same day as their procedure, surgeons will narrow their bladder neck to the diameter just larger than a 3-way Foley catheter to limit the need for post-operative CBI. We are going to be very interested to see what the rates of bladder neck contracture are going to be using this technique, because it is almost the exact opposite approach that we are taking by trying to open up the bladder neck as much as possible after our laser enucleation procedure. So, that's something that we're very interested in seeing moving forward.

This transcription has been edited for clarity.