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.