Simultaneous Prostate Laser Surgery and Biopsy: Is It Safe?

Simultaneous transurethral laser prostatectomy and biopsy procedure?

Dr.
Tsai: Hello, my PSA levels are increasing rapidly, and due to benign prostatic hyperplasia, my urinary flow rate is very low.
After evaluation by my doctor, there is concern about the possibility of a tumor.
Therefore, the planned procedure includes a biopsy (I requested anesthesia during the biopsy because I am afraid of pain) and simultaneously performing a holmium laser enucleation of the prostate.
I would like to ask if these two procedures can be done at the same time? My understanding is that typically one procedure is done first, and then the other is done after some time.
If they can be performed simultaneously, what is the associated risk? Thank you.

keng, 60~69 year old female. Ask Date: 2021/09/27

Dr. Cai Zhuorong reply Urology

It is feasible to perform two surgeries simultaneously.
Of course, if there is a high suspicion of prostate cancer, a biopsy can be performed first.
Once the biopsy confirms the presence of a malignant tumor, a radical prostatectomy can be scheduled.
This approach can save the costs associated with laser ablation surgery.

Reply Date: 2021/09/27

More Info

When considering the simultaneous performance of prostate laser surgery and biopsy, it is essential to evaluate both the safety and the potential risks involved. The combination of these two procedures is indeed feasible and can be beneficial in certain clinical scenarios, particularly when there is a suspicion of prostate cancer alongside benign prostatic hyperplasia (BPH).

Safety of Simultaneous Procedures
The safety of performing a prostate biopsy and laser surgery at the same time largely depends on the patient's overall health, the specific techniques used, and the experience of the surgical team. In many cases, combining these procedures can reduce the need for multiple anesthetic exposures and hospital visits, which can be advantageous for the patient. However, it is crucial to ensure that the surgical team is well-prepared and experienced in managing both procedures simultaneously.

Risks Involved
While the simultaneous approach can be safe, it is not without risks. Some of the potential complications include:
1. Bleeding: Both procedures can lead to bleeding, and performing them together may increase the risk of significant blood loss. Monitoring and managing this risk is essential.

2. Infection: Any invasive procedure carries a risk of infection. The simultaneous procedures may increase this risk, particularly if proper sterile techniques are not followed.

3. Urinary Retention: After laser surgery, some patients may experience urinary retention, which could complicate the recovery process if a biopsy is also performed.

4. Pain and Discomfort: Patients may experience increased pain or discomfort due to the combined nature of the procedures. Adequate pain management strategies should be in place.

5. Diagnostic Challenges: If the biopsy reveals cancerous cells, the subsequent treatment plan may need to be adjusted, which could complicate the initial intent of performing both procedures together.

Considerations for Patients
Patients should discuss their specific situation with their healthcare provider to understand the rationale behind performing both procedures simultaneously. Factors such as the size of the prostate, the degree of urinary obstruction, and the patient's overall health status will influence the decision.

It is also important for patients to be aware of their rights regarding pain management during the biopsy. If anxiety about pain is a concern, discussing options for sedation or anesthesia with the physician is advisable.

Conclusion
In summary, simultaneous prostate laser surgery and biopsy can be a safe and effective approach for patients with suspected prostate cancer and significant urinary symptoms due to BPH. However, it is crucial to weigh the benefits against the potential risks and complications. Open communication with the healthcare team, understanding the procedures involved, and having a clear post-operative care plan are vital for ensuring the best possible outcomes. Always consult with a qualified urologist to tailor the approach to individual needs and circumstances.

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