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Objective We aimed to assess the success rate of the GreenLight laser photoselective vaporization of the prostate (GLL PVP) procedure for enlarged prostates in patients with and without preoperative long-term catheters. Methodology A retrospective data analysis was conducted on 46 patients. Data were collected from clinical health records and radiology images. The parameters studied in this analysis included the patient's age, prostate volume, medical management before surgery, and whether the patient had a catheter or not prior to the surgery. Results A total of 46 GLL PVP surgeries were performed over a 12-month period from May 2023 to May 2024 at West Middlesex University Hospital in London. Patients had a mean age of 73.2 ± 8.12 years, and their prostate volume was 57.7 ± 25.96 cc. Before the surgery, 14 cases (30%) were using long-term catheters, and 32 cases (70%) were not. Additionally, 40 cases (87%) were receiving medical management for lower urinary tract symptoms (LUTS). After the surgery, 39 cases (85%) passed their first trial without catheter (TWOC), and seven cases (15%) failed it, regardless of whether they had used catheters before the surgery. Patients using long-term catheters before the operation had a 71% success rate in passing their first TWOC and a 29% failure rate. Conclusion Our study found that GLL PVP has a significant positive impact on elderly individuals with a large prostate volume, regardless of whether they had long-term catheters or not prior to the operation. Additionally, our findings indicate that patients without preoperative long-term catheters experience significantly better outcomes.

A 72-year-old high-risk male presented to our hospital with severe bladder outlet obstruction (BOO) caused by an enlarged prostate with a volume exceeding 130 cc. Subsequently, the patient successfully underwent GreenLight laser (Boston Scientific, Marlborough, MA, USA) photoselective vaporization of the prostate (PVP). The patient had been unsuitable for conventional surgical modalities such as transurethral resection of the prostate (TURP) or open prostatectomy due to multiple pre-existing comorbidities, including coronary artery disease (CAD), atrial fibrillation (AF), and concurrent use of antiplatelet therapy. The GreenLight PVP procedure was uneventful and significantly improved urinary symptoms and the patient's quality of life (QoL). This case demonstrates the effectiveness of GreenLight laser PVP as a minimally invasive and effective treatment option for high-risk patients with large prostate volumes (>100 cc).

Background Efficient healthcare delivery and access to specialized care rely heavily on a well-established healthcare sector referral system. However, the referral system faces significant challenges in developing nations like Bangladesh. This study aimed to assess self-referral prevalence among patients attending tertiary care hospitals in Bangladesh and identify the associated factors. Methods This cross-sectional study was conducted at two tertiary care hospital, involving 822 patients visiting their outpatient or inpatient departments. A semi-structured questionnaire was used for data collection. The patients’ mode of referral (self-referral or institutional referral) was considered the outcome variable. Results Approximately 58% of the participants were unaware of the referral system. Of all, 59% (485 out of 822) of patients visiting tertiary care hospitals were self-referred, while 41% were referred by other healthcare facilities. The primary reasons for self-referral were inadequate treatment (28%), inadequate facilities (23%), critical cases (14%), and lack of expert physicians (8%). In contrast, institutional referrals were mainly attributed to inadequate facilities to treat the patient (53%), inadequate treatment (47%), difficult-to-treat cases (44%), and lack of expert physicians (31%) at the time of referral. The private facilities received a higher proportion of self-referred patients compared to government hospitals (68% vs. 56%, p  < 0.001). Among patients attending the study sites through institutional referral, approximately 10% were referred from community clinics, 6% from union sub-centers, 25% from upazila health complexes, 22% from district hospitals, 22% from other tertiary care hospitals, and 42% from private clinics. Patients visiting the outpatient department (adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 2.28–4.82, p  < 0.001), residing in urban areas (aOR 1.29, 95% CI 1.04–1.64, p  = 0.007), belonging to middle- and high-income families (aOR 1.34, 95% CI 1.03–1.62, p  = 0.014, and aOR 1.98, 95% CI 1.54–2.46, p  = 0.005, respectively), and living within 20 km of healthcare facilities (aOR 3.15, 95% CI 2.24–4.44, p -value < 0.001) exhibited a higher tendency for self-referral to tertiary care facilities. Conclusions A considerable number of patients in Bangladesh, particularly those from affluent urban areas and proximity to healthcare facilities, tend to self-refer to tertiary care centers. Inadequacy of facilities in primary care centers significantly influences patients to opt for self-referral.

Objective Our study was designed to evaluate the postoperative urinary retention (UR) and success rate of the GreenLight Laser (Boston Scientific, Marlborough, MA, USA) photoselective vaporization of the prostate (GLL.PVP) procedure for Benign Prostatic Hyperplasia (BPH) patients, both with and without high-risk factors. Methodology We conducted a retrospective follow-up study of postoperative patients who underwent GLL.PVP for BPH. We collected data from clinical health records, including notes from the lower urinary tract symptoms (LUTS) clinic, trial without catheter (TWOC) clinic, and emergency department presentations with UR. The analysis examined several parameters, including the patient's age, high-risk factors, prostate volume, and both preoperative and postoperative objective voiding parameters. These voiding parameters included post-void residual (PVR) and maximum flow rate (Qmax). Additionally, the analysis looked into whether the patient had a catheter or experienced urinary retention prior to the surgery. Results A total of 50 GreenLight Laser PVP surgeries were performed over a 14-month period from May 2023 to July 2024 at West Middlesex University Hospital in London. Most of the patients were between the ages of 60 and 80. Prior to the surgery, data indicated that 17 patients (34%) were using long-term catheters, whereas 33 patients (66%) were not. Additionally, 25 patients (50%) were identified as having high-risk factors, which included being on anticoagulation therapy, a history of urinary retention, and a prostate volume exceeding 100 cc. Notably, the patient without h/o urinary retention had an average preoperative PVR of 150 mL and an average Qmax of 7 mL/second In our 3-6 month retrospective postoperative follow-up study, we found that eight cases (16%) developed urinary retention, while 42 cases (84%) did not, with an average PVR volume of 105 mL and an average Qmax of 13.5 mL/second. In patients with preoperative urinary retention, 13 cases (76%) did not develop UR postoperatively whereas four cases (24%) developed. Conclusion Our study conclusively found that 42 cases (84%) of patients did not experience urinary retention (UR) in the follow-up after undergoing the GLL PVP operation, irrespective of any history of urinary retention or other high-risk factors. This unequivocally demonstrates the operation's efficacy. Furthermore, our findings revealed that three-quarters of patients with a preoperative history of urinary retention also did not develop UR post-surgery. The GLL.PVP procedure is safe and effective, leading to rapid improvements in voiding parameters.

Renal angiomyolipoma (AML) is a benign mesenchymal tumor that is often treated with transcatheter arterial embolization (TAE) to prevent complications such as hemorrhage. Although TAE is generally effective, it can lead to complications, including renal ischemia and atrophy. We present the case of a 72-year-old woman who underwent embolization for a right renal AML. After the procedure, she experienced damage to the renal artery, which resulted in progressive kidney shrinkage and impaired renal function. This case highlights the potential complications of embolization in managing renal AML and highlights the necessity for the long-term monitoring of renal function after the procedure.

This study aimed to evaluate first-time trial without catheter (TWOC) outcomes and postoperative urinary retention rates during short-term follow-up at three to six months in men with long-term catheterisation (LTC) or intermittent self-catheterisation (ISC) undergoing GreenLight laser photoselective vaporisation of the prostate (GLL.PVP). This retrospective observational study included 20 consecutive men with benign prostatic hyperplasia (BPH) who were dependent on LTC or ISC and underwent GLL.PVP between May 2023 and July 2024 at a tertiary centre in the United Kingdom. During this period, 50 GLL.PVP procedures were performed, and these 20 cases represented all eligible catheter-dependent patients who met the inclusion criteria. Data were collected from clinical health records, including postoperative documentation, lower urinary tract symptoms (LUTS) clinic notes, TWOC clinic assessments, and emergency department presentations with urinary retention. Parameters analysed included patient age, prostate volume, catheter status, high-risk factors, and objective voiding parameters such as post-void residual urine volume (PVR) and maximum urinary flow rate (Qmax). The primary endpoint was first-time TWOC success, and the secondary endpoint was catheter-free status at three to six months. The mean patient age was 72.8 ± 8.6 years, and the mean prostate volume was 72.5 ± 36.3 mL. Prior to surgery, 18 patients (90%) were managed with LTC and two (10%) with ISC. Nine patients (45%) were identified as high-risk due to anticoagulation therapy, prostate volume greater than 100 mL, or recurrent urinary retention. First-time TWOC was successful in 15 patients (75%), while five patients (25%) failed. At three to six months, 16 patients (80%) remained catheter-free, whereas four patients (20%) experienced recurrent urinary retention requiring re-catheterisation. Among patients who achieved catheter-free status postoperatively, the average PVR was 95 mL, and the average maximum urinary flow rate (Qmax) was 12.8 mL/s. GLL.PVP appears to be a safe and feasible intervention for catheter-dependent men with BPH, demonstrating encouraging short-term outcomes with a high rate of successful first-time TWOC and sustained catheter-free status. These findings provide preliminary evidence supporting the potential role of GLL.PVP as a minimally invasive option for restoring spontaneous voiding in men with chronic catheter dependence.