Percutaneous Endoscopic Polypectomy
For patients with BP-RMS confined to the prostate and baldder neck up to the level of the trigone, open surgery was not required. However, those with large exophytic tumour polyps, which risk obstructing voiding, were offered percutaneous endoscopic laser polypectomy. Under cystoscopic vision (9.5Fr cystoscope, Storz®), a suprapubic needle puncture into the bladder above the tumour allowed placement of a 0.035Fr Sensor PTFE-Nitinol guidewire (Boston Scientific®). The tract was dilated by 7Fr rigid dilator (Cook®) followed by a Nephromax balloon (Boston Scientific®). Via a 18Fr or 30Fr Amplatz sheath (Boston Scientific®), a 15Fr or 20.8Fr R.Wolf® nephroscope allowed any tumour polyps to be assessed in terms of their potential to create a ball-valve effect over the bladder neck and posterior urethra. Holmium:YAG laser (Cook®) at 0.5-1J and 5-15Hz long-setting allowed the stalk of the polyp to be coagulated and divided. The polyp was extracted via the Amplatz sheath preventing contamination of the tract. This suprapubic access was also used to obtain bladder “mapping” biopsies for patients whose urethra was too narrow to accept the biopsy cystoscope.