Salvage greenlight laser prostatectomy following previous failed urolift

Introduction: Decisions on benign prostatic enlargement management are becoming increasinglycomplex because of the availability of various treatment modalities. Urolift is one such option, offeredfor patients with small-to-moderate (<80 cc) glands, particularly those wishing to preserve sexualfunction. Greenlight laser prostatectomy (GLLP) may also be offered for similarly sized prostates andis gaining popularity ahead of transurethral resection of prostate. With reintervention rates between5% and 14% for Urolift, we present video footage from the case of a patient who underwent a GLLPsubsequent to a previous Urolift. 

Scenario: A 62-year-old man underwent a Urolift for troublesome lower urinary tract symptoms(LUTS), at a previous National Health Service Trust, a year before presenting locally with progressionof symptoms. He was diagnosed with low-pressure chronic retention and underwent a GLLP afterprostate volume assessment.

Results: The patient underwent an effective day-case GLLP and passed his trial removal of catheter5 days later. We present an operative video of the steps, as a point of technique for removal of Uroliftimplants in such patients. The steps include formation of anterior channels after initial cystoscopy,followed by lateral lobe vaporization. Prior knowledge of implant position enables safe lasing of thesuture (not the clip) and release of the implant, which is washed out at the end of the operation. 

Conclusion: GLLP is a viable and safe option for refractory LUTS post-Urolift. The implants do notimpede the laser energy and, with knowledge of where they are typically placed, are explanted withrelative ease.