Patients with Benign Prostate Hyperplasia Evaluated for Infection after Holmium Laser Surgery

Patients with Benign Prostate Hyperplasia Evaluated for Infection after Holmium Laser Surgery

Researchers at Gifu University Hospital in Japan examined the presence of postoperative bacteria in the urine (bacteriuria) and fever complications in patients with benign prostatic hyperplasia (BPH) who undergo holmium laser removal of tissue inside the prostate.

Called holmium laser enucleation of the prostate (HoLEP), the minimally invasive treatment for BPH, removes the prostate gland tissue, leaving just the gland capsule in place. The surgeon then pushes the removed tissue into the bladder where a device, called a morcellator, is used to grind up the tissue before it is finally removed from the body.

The research paper,“Postoperative infectious complications in patients undergoing holmium laser enucleation of the prostate: Risk factors and microbiological analysis,” published in the International Journal of Urology, suggests that using prophylactic antibacterial drugs before the procedure keeps the rate of infections low, and that using the drug dutasteride before surgery might reduce the risk of postoperative bacteriuria.

Managing lower urinary tract symptoms (LUTS) and BPH usually includes medication, but such drug treatments can lead to side effects such as dizziness, headache, and sexual dysfunction.

In patients unresponsive to drug therapies or who develop related complications, surgeries that cut or ablate prostate size are the alternative – such as transurethral resection of the prostrate (TURP) in which the prostrate is removed via the urethra.

Although TURP yields high success rates in relieving symptoms, it is also associated with side effects that including bleeding, incontinence, and erectile dysfunction.

HoLEP has been established as an alternative to TURP for the treatment of BPH, because of the procedures’ better postoperative outcome and low complication rate. Urinary tract infections and other infectious complications mainly follow the procedure. There are few reports on postoperative infectious complications that occur after HoLEP.

According to the study, researchers retrospectively analyzed 190 patients with LUTS and BPH before the HoLEP procedure. Researchers found that the frequency of bacterial isolation in preoperative and postoperative urine cultures was 41% and 23%, respectively. Additionally, the rate of febrile complications after HoLEP was 10%;  infectious complications was 2.1%.

Febrile complications occurred in nine (11%) of the 78 patients whose urine cultures were positive. The decreased rate of perioperative bleeding in HoLEP might be associated with a reduced rate of postoperative bacteriuria.

Researchers suggested that the drug dutasteride can reduce the rate of postoperative bacteriuria, although the mechanism of the drug remains to be determined.

The study concluded: “the use of perioperative prophylactic antibacterial agents for HoLEP at our hospital kept the rates of postoperative infectious complications low. The risk factors for febrile complications were not clear. Dutasteride treatment administered before surgery might reduce the risk of postoperative bacteriuria.”

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