Safety and Effectiveness of Combined HoLEP and Transurethral Treatment for Large Bladder Diverticula

Overview

This retrospective study reports outcomes of seven patients undergoing combined Holmium laser enucleation of the prostate (HoLEP) with transurethral endoscopic management of symptomatic large bladder diverticula (BD). The combined approach demonstrated favorable perioperative safety, effective symptom relief, and significant improvement in urinary function at 3 months.

Background

Bladder diverticula (BD) commonly occur secondary to benign prostatic obstruction (BPO), with large diverticula posing risks such as urinary retention and recurrent infections. Traditional management includes open or robotic diverticulectomy, while transurethral techniques combined with prostate surgery have been less frequently utilized in recent decades. Holmium laser enucleation of the prostate (HoLEP) is an established size-independent alternative to TURP for BPO, but its combination with transurethral BD treatment has not been previously studied. This study evaluates the safety and efficacy of this combined approach (C-HoLEP-TUBD) in contemporary practice.

Data Highlights

Key Findings

• Combined HoLEP with transurethral BD management is feasible and safe in symptomatic large BD patients.
• Intraoperative cystogram and bipolar cautery fulguration with neck resection effectively treated the diverticula.
• Patients showed significant improvement in lower urinary tract symptoms (IPSS) and urinary flow parameters at 3 months.
• Postoperative imaging confirmed resolution or reduction of bladder diverticula size.
• No major complications or need for staged open or robotic diverticulectomy were reported during follow-up.

Clinical Implications

The combined HoLEP and transurethral endoscopic approach offers a minimally invasive, effective treatment option for patients with symptomatic large bladder diverticula secondary to BPO. This technique may reduce the need for more invasive surgeries, shorten hospital stays, and improve patient recovery. Clinicians should consider this approach especially in patients suitable for endoscopic management and those at higher risk for open or robotic procedures.

Conclusion

This study supports the safety and efficacy of concomitant HoLEP and transurethral bladder diverticulum management, suggesting a renewed role for classic transurethral techniques in modern urologic practice. Further larger studies are warranted to confirm these findings.

References

1. American Urological Association Guidelines -- Management of LUTS due to BPO
2. Previous case series and reports (1992-2014) -- Combined TURP and endoscopic BD management
3. Studies on HoLEP as alternative to TURP -- 1990s to present
4. Institutional protocol and surgical technique descriptions -- 2017-2024