Urology- BPH Diode Laser Treatment

Keywords: Prostate; Cysts; Laser; Transurethral

Abbreviations: LUTS: Lower Urinary Tract Symptoms; IPSS:
International Prostate Symptoms Score; QOL: Quality of Life;
KUB: Kidney Ureter Bladder; TRUS: Trans Rectal UltraSound; CT:
Compuerized Tomography; MRI: Magnetic Resonance Imaging; DRE:
Digital Rectal Examination

Case Report
A 43 years old gentleman presented to our clinic with complaints
of lower urinary tract symptoms (LUTS). The symptoms were straining
to pass urine, dysuria, frequency, urgency discomfort in inguinal and
abdominal region. Decrease in flow was severe that he strained to
maintain a flow and had frequency every one hour. All his symptoms
were present since 1year but severe since 3 months. He is a known
diabetic on regular oral hypoglycemic agents since 10 years. DRE was
done in the clinic and was normal with normal prostate size and no
tenderness. Urine analysis and culture came out to be normal. Serum
total PSA test was 0.5 ng/ml. International Prostate Symptoms Score
(IPSS) at presentation was 28 and Quality of Life score (QOL) was 6 at
presentation.

Ultra Sound Scan KUB showed both kidneys are of average size,
shape with regular outline, no evidence of masses, back pressure or
cystic changes. Good cortico-medullary differentiation and adequate
parenchymal thickness. No evidence of free or loculated intraperitoneal
or pelvic fluid collections. The maximum capacity of
the urinary bladder was 500 ml with no masses or calculi. Post void
residual urine was significant at 240 ml. Prostate was of average size
(2.87×3.09×3.26-15.138 cc) (Figure 1) but with an anechoic oval
lesion with thin and smooth walls near the midline very close to the
bladder neckprobably a prostate cyst. The size of the prostate cyst was
1.06×1.14×1.59 (Figures 2 and 3).
Uroflowmetry showed a max flow of 5.7 ml/sec and a mean flow of
2.7 ml/sec for a voided volume of 230 ml. (Figure 4). The impression
was a bladder outlet obstruction due to a Prostate cyst or a bladder neck
hyper trophy.
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