Successful TURP, Laser Cystolithotripsy for Enlarged Prostate and Bladder Stones

Chief Complaints

A 72-year-old male patient with a body mass index (BMI) of 21 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of poor urine flow and swelling at the back of the right arm.

The patient had no significant comorbidities. The patient had no known drug allergies, and there was no history of hypersensitivity reactions to any medications, food items, or other substances.

On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. Abdominal examination revealed a distended bladder with features suggestive of lower urinary tract obstruction. Local examination showed a soft tissue swelling over the posterior aspect of the right arm consistent with a lipomatous lesion, with no signs of inflammation. No other significant systemic abnormalities were detected.

Upon admission to PACE Hospitals, the patient was thoroughly evaluated by the Urology team, including a detailed review of his medical history and a comprehensive clinical examination. He presented with poor urine flow and swelling over the posterior aspect of the right arm, along with features suggestive of lower urinary tract obstruction.

The patient underwent diagnostic investigations, including appropriate imaging and pre-operative assessment, which confirmed benign prostatic enlargement with lower urinary tract symptoms, vesical calculi, and a right arm lipomatous lesion. Pre-operative evaluation also revealed a raised Prostate Specific Antigen (PSA) level, and MRI of the prostate showed a PIRADS 2 lesion. Laboratory investigations were within acceptable limits for surgical management. Cardiovascular, respiratory, abdominal, and neurological examinations were stable with no significant abnormalities.

Based on these confirmed findings, the patient was advised to undergo Benign Prostatic Enlargement with Lower Urinary Tract Symptoms, Vesical Calculi, and Right Arm Lipoma Treatment in Hyderabad, India, under the expert care of the Urology Department.

After a detailed consultation with Dr. Abhik Debnath, Consultant Laparoscopic Urologist, and Dr. Kantamneni Lakshmi, Consultant Plastic and Aesthetic Surgeon, a comprehensive evaluation was conducted focusing on the patient’s presentation of poor urine flow, lower urinary tract symptoms, and swelling over the posterior aspect of the right arm, along with diagnostic findings suggestive of benign prostatic enlargement, vesical calculi, and right arm lipomatous lesion. Cross consultation and clinical assessment confirmed a trilobar occlusive prostate with trabeculated bladder, multiple vesical calculi, and a benign lipomatous swelling of the right arm.

It was determined that transurethral resection of prostate (TURP) with laser-assisted cystolithotripsy and excision of right arm lipoma was the most appropriate combined surgical management to relieve bladder outlet obstruction, clear vesical calculi, and excise the lipomatous lesion, thereby improving urinary flow, preventing recurrent urinary retention, and addressing the soft tissue swelling.

The patient and his family members were informed about the diagnosis of benign prostatic enlargement with lower urinary tract symptoms, vesical calculi, and right arm lipoma, along with the input from cross consultations, the planned surgical management, and the associated risks, benefits, and expected outcomes aimed at symptom relief and improved functional outcomes.

Following the decision, the patient was scheduled to undergo a Transurethral resection of prostate (TURP) with laser-assisted cystolithotripsy and excision of right arm lipoma in Hyderabad at PACE Hospitals, under the expert care of the urology department.

The procedure involved the following steps:

• Anaesthesia and Patient Positioning: The patient was taken up for surgery under general anaesthesia after appropriate pre-anaesthetic evaluation. He was positioned in the lithotomy position for the endoscopic urological procedures, and the right upper limb was prepared and draped separately for excision of the lipomatous lesion under strict aseptic precautions.

• Endoscopic Assessment of Bladder and Prostate: Cystoscopic evaluation revealed a trilobar occlusive prostate with a significantly trabeculated urinary bladder. Multiple vesical calculi were identified within the bladder cavity, confirming bladder outlet obstruction secondary to benign prostatic enlargement.

• Transurethral Resection of Prostate (TURP): Transurethral resection of the prostate was performed to relieve bladder outlet obstruction. Prostatic tissue was systematically resected to create a wide and patent prostatic channel, improving urinary flow and relieving lower urinary tract symptoms.

• Laser Cystolithotripsy and Hemostasis: Laser energy was utilized for fragmentation of multiple vesical calculi and also for prostate tissue management. A roller ball electrode was employed to achieve additional and complete hemostasis, ensuring control of intraoperative bleeding.

• Excision of Right Arm Lipoma: A lobulated lipomatous lesion over the right arm was excised through a separate incision. The lesion was carefully dissected and removed in toto, ensuring complete excision while preserving surrounding soft tissue structures. Hemostasis was secured, and the wound was closed in layers.

The patient had an uneventful intraoperative and postoperative course with stable recovery. Surgical sites were regularly monitored, and dressings were done on the second postoperative day, with the arm wound noted to be healthy and healing well without signs of infection or complications. The urinary catheter was removed after ensuring adequate bladder function and satisfactory voiding. The biopsy report confirmed that the prostate enlargement was benign (non-cancerous) and the right arm swelling was a lipoma, also a benign (non-cancerous) fatty lump. The patient was discharged in stable condition with advice on routine follow-up and postoperative care.

The patient had an uneventful intraoperative and postoperative course with stable recovery. Surgical sites were regularly monitored, and dressings were done on the second postoperative day, with the arm wound noted to be healthy and healing well without signs of infection or complications. The urinary catheter was removed after ensuring adequate bladder function and satisfactory voiding. The biopsy report confirmed that the prostate enlargement was benign (non-cancerous) and the right arm swelling was a lipoma, also a benign (non-cancerous) fatty lump. The patient was discharged in stable condition with advice on routine follow-up and postoperative care.

The patient was advised to follow a high-fiber diet to maintain bowel regularity and prevent constipation. He was instructed to maintain adequate hydration with a fluid intake of 2–3 liters per day. He was also advised to avoid tea, coffee, and spicy foods and to refrain from straining during urination and defecation to support smooth postoperative recovery.

The patient was instructed to contact the emergency ward at PACE Hospitals in the event of an emergency or development of any symptoms such as fever, abdominal pain, dysuria, hematuria, urinary retention, or wound discharge, in order to ensure timely medical evaluation and management.

The patient was advised to return for a follow-up visit with the Urologist in Hyderabad at PACE Hospitals and the Plastic Surgeon after 4 days for wound review and postoperative assessment.

This case highlights the successful surgical management of benign prostatic enlargement with lower urinary tract symptoms, vesical calculi, and a right arm lipomatous lesion. The patient underwent endoscopic prostate surgery with laser-assisted stone fragmentation and excision of the lipoma without any complications. Histopathology confirmed benign disease with an uneventful postoperative recovery and stable discharge.