Gupta Narmada P, Kumar Rajeev, Yadav Rajiv
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Objectives: The use of the standard monopolar electrocautery is associated with significant risks of implant malfunction in patients on a cardiac pacemaker. It is also associated with a risk of adverse cardiac events due to blood loss and fluid absorption. The properties of the holmium laser prevent the occurrence of these adverse events. We report the successful use of this technology in resecting the gland in patients on a permanent cardiac pacemaker implant.
MATERIALS AND Methods: Six patients with permanent cardiac pacemaker implant were treated with holmium laser resection of prostate over a period of two years. Treated patients had bothersome prostatic symptoms and failed to respond to medical therapy. All patients were operated under spinal anesthesia using a high power VersaPulse® PowerSuiteTM Holmium laser source. Normal saline was used as irrigant. Intravesical tissue morcellator was also used to remove the larger fragments in two of the patients.
Results : Median patient age was 60 years (range 56-73) and median prostate volume was 40cc (range 20-48cc). None of the patient required blood transfusion or had significant hyponatremia or Transurethral resection syndrome. No patients had any pacemaker malfunction or hemodynamic instability during the procedure or in immediate postoperative period. Improvement in maximum urine flow rate was observed from an average of 7 ml/sec in preoperative period to 22 ml/sec postoperatively at 3 month followup.
Conclusions: Holmium laser prostatectomy offers the ideal modality of surgery in patients on a cardiac pacemaker. It helps to avoid additional preparation and minimizes the risk of device malfunction and adverse post operative events.