Introduction: Chronic bacterial prostatitis can be a difficult condition to treat due both the variable tissue penetrance of antibiotics in the prostate, as well as the sometimes uncertain interaction between bacteria and prostatic stones. We present this video as both a demonstration of the atypical nature of this patient’s stone burden, as well as the multiple strategies employed to treat the stones. This patient presented with seven years of irritative voiding symptoms refractory to alpha-adrenergic blockers, long-term courses of antibiotics and serial prostatic message. His preoperative American Urological Association Symptom Index (AUASI) was 22 and his Quality of Life Score (QoL) was 4. MRI demonstrated a very large prostatic stone burden.
Methods: The procedure was performed using a 26 French Storz Resectoscope with both a Collins Knife electrocautery device and a 365 micron Holmium laser fiber via a laser bridge. The patient underwent unroofing of a large cavity within the prostate using the Collins Knife, and then stone fragmentation, further cavity resection, and hemostasis using the Holmium laser. Given the difficulty of removing stones with the resectoscope directly from the prostatic cavity, an Ellik evacuator was used to blow the stones into the bladder from which they were then easily drained through the sheath.
Results: The patient was discharged with a short course of antibiotics and a urethral catheter from the ambulatory surgery center and recovered well postoperatively. His catheter was removed on postoperative day seven and he passed a voiding trial. At his six-week follow-up appointment, he was voiding well and symptom free. His follow-up AAUSI was 14 and his QoL was 0.
Conclusions: We found the use of both the Collins Knife electrocautery device and Holmium laser to be effective tools in the armamentarium to treat prostatic stones associated with chronic prostatitis. Our results demonstrate the importance of imaging and the role of nidus removal in the treatment of refractory chronic bacterial prostatitis.