Can minimally invasive laser surgery treat BPH and bladder stones at the same time?

This study compared the outcomes of a combined minimally invasive laser surgery to treat benign prostatic hyperplasia (BPH) and bladder stones at the same time. Authors concluded that combined minimally invasive laser surgery is safe and effective in men with BPH and bladder stones.

BPH can lead to bothersome urinary symptoms that can affect quality of life. Surgery is often required to remove enlarged prostate tissue. Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure to treat BPH. HoLEP allows for the destruction of prostate tissue with a laser inserted into the urethra (the penile opening).

A similar procedure is used to to remove bladder stones. Holmium laser cystolitholapaxy (HLC) involves delivering a laser through the urethra to break up the bladder stones. Having bladder stones as well as BPH can lead to severe urinary symptoms. Whether HoLEP and HLC can be combined to treat both bladder stones and BPH at the same time has not been fully studied.

The aim of this study was to compare the outcomes of HoLEP with and without simultaneous HLC.

The records of 320 men undergoing HoLEP to treat BPH were included in analysis. Of these, 41 underwent HLC during the same procedure as HoLEP. The safety and effectiveness of HoLEP alone or combined laser surgery was followed for up to 12 months.

HoLEP alone and in combination with HLC significantly improved urinary symptoms. Quality of life, symptom bother, urinary flow rate, and complete bladder emptying were all similarly improved in both treatment groups at 12 months.

Combined laser surgery was longer (average 172 minutes) than HoLEP alone (average 146 minutes). Men undergoing combined laser surgery also had a significantly higher rate of urinary incontinence (26.8%) after the procedure compared to HoLEP alone (12.5%). However, most men recovered within 3 to 6 months. Only 0.8% of men undergoing combined laser surgery had long-term urinary incontinence.

There were no differences in blood loss during surgery, length of hospital stay, or length of catheterization (flexible tube inserted into the bladder to drain urine). The overall rate of side effects was less than 5%.

Authors concluded that HoLEP with HLC is safe and effective in men with BPH and bladder stones.

Larger studies that randomly assign men with BPH and bladder stones to treatment groups are needed to confirm these results.