LAUSR

Purpose: To characterize the role of perineal urethrostomy in patients undergoing HoLEP for BPH symptom relief. Methods: We identified all patients who required the creation of a perineal urethrostomy from a prospectively maintained institutional database between 1998-2017. Patient demographics, as well as operative and postoperative records, were analyzed to evaluate differences in those patients requiring a perineal urethrostomy. Results Obtained: We identified 7 patients who underwent HoLEP and required a perineal urethrostomy. The mean age was 70 years old (range: 61-82 years old). Within this subset of patients, four had previously aborted BPH procedures; two had penile prosthesis and two were morbidly obese. The mean final prostate specimen weight was 111 grams (range: 23-319). The duration of catheterization varied from 37-600 hours. In patients with BMI ?40kg/m2 , the average duration of catheterization was 588 hours compared 119 hours in patients with BMI <40kg/m2 . At the six-month follow-up, no patient reported daytime incontinence. No strictures, fistulae, or diverticula were identified in these patients. Conclusion: Utilizing a temporary perineal urethrostomy during HoLEP, or any transurethral BPH procedure, for a small subset of patients with challenging anatomy represents an important skill in the endoscopist’s armamentarium. We note no adverse events aside from prolonged urinary catheterization. Surgeons should consider temporary perineal urethrostomy in lieu of aborting the procedure with the knowledge that it is safe and presents minimal long-term risks.