Minimally invasive removal of Leiomyomas of the lower urinary tract via transurethral surgery by using the minimal suturing device (MSD-Ney)

Neymeyer J1, Mala K1, Schaeff V1, Weinberger S1, Schlomm T1

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

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Abstract 236
Female Pelvic Floor Disorders
Scientific Podium Short Oral Session 22
Friday 25th October 2024
10:07 - 10:15
Hall N102
Pelvic Floor New Devices New Instrumentation Female Voiding Dysfunction
1. Medical University Charite - Berlin
Presenter
Links

Abstract

Hypothesis / aims of study
Leiomyomas are benign tumors of smooth muscle origin and are rarely found in the lower urinary tract. Removal is often technically challenging due to a location deep in the pelvis with difficult exposition.
Study design, materials and methods
Data from seven patients with leiomyoma of the lower urinary tract and treated via transurethral surgery in Notes-technique by using the minimal suturing device instruments. Between May 2016 and December 2023, was analyzed retrospectively. Analysis included number, size and localization of the leiomyomas, symptoms, voiding function and complications. Preoperatively the diagnosis was confirmed by ultrasound guided biopsy.
Setting: A rigid cystoscope with 30 degree optics is inserted into the bladder with CO(2) insufflation. After inspecting and finding the lyomyoa is manipulated and cut out with an endoscopic hooklet. First the monocryl 3-0 fibre is put into the needle holder. To fit into the needle is bended. The needle is put loose next to the cystoscope put into the bladder and after touching the wall the fibre is fixed at the end of the needle holder with a clamp. Now by a rotation the whole is at both sides stiched. With a grasp -put through the working channel- the needle is grasped and by loosing the clamp everything can be pulled out. By tying an extracorporal knot and putting an knot pusher over the fibre, the knot is fixed. This procedure is repeated till the whole is closed. The fibres are cutted.
Results
Patients presented with signs and symptoms including a palpable external genital mass, dysuria, urge urinary incontinence or dyspareunia. Usually physical examination revealed a non-tender mass, 1.2-2.8cm in diameter, with a smooth surface located above the urethra or bladderneck. The masses were sharply dissected and enucleated via transurethral bladderoscopy. No postoperative complications were found. Two weeks after the procedure, all patients had a normal voiding function. Terminal histopathological examination showed leiomyomas with fascicles with spindle-shaped cells without mitosis.
Interpretation of results
To reduce morbidity and prolonged recovery of Leiomyomas of the lower urinary tract - TUS-NOTES technique is efficacious and the preferred method of intervention. The mean operative time was 55 min (35min-110min), whereas the blood loss was less 10ml. The patients were discharged 3 days after surgery, and the catheter were removed 10 days after surgery.
Concluding message
In management of Leiomyomas of the lower urinary tract, a transvesical approach via bladderoscopy is a safe and feasible alternative to laparoscopic or transvaginal treatment. To reduce morbidity and prolonged recovery of excision of the Leiomyomas of the lower urinary tract - TUS-NOTES technique is efficacious and the preferred method of intervention. The prognosis is excellent since it has no risk of malignant transformation.
Figure 1
Disclosures
Funding none Clinical Trial No Subjects Human Ethics not Req'd Retrospective study Helsinki Yes Informed Consent Yes
Citation

Continence 12S (2024) 101578
DOI: 10.1016/j.cont.2024.101578

19/11/2024 18:41:53