A Rare Case of Bladder Neck Obstruction Caused by Extrusion of Necrotic Tissue Following Transurethral Water Vapor Energy Therapy for Benign Prostatic Hyperplasia

TL;DR

A rare complication of WAVE therapy for enlarged prostate caused bladder blockage from necrotic tissue, requiring endoscopic removal.

Contribution

Reports a rare case of bladder neck obstruction due to necrotic tissue extrusion after WAVE therapy for BPH.

Findings

A 67-year-old man developed urinary retention after WAVE therapy due to a calcified mass at the bladder neck.

Endoscopic removal of the necrotic tissue resolved the obstruction and improved urinary symptoms.

This case underscores the need for clinicians to consider this rare complication in post-WAVE patients with delayed voiding issues.

Abstract

Transurethral water vapor energy (WAVE) therapy is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that typically results in coagulative necrosis without significant clinical sequelae. However, rare complications such as urinary tract obstruction due to sloughed necrotic tissue have been reported.

We report the case of a 67-year-old man with BPH who developed acute urinary retention and underwent WAVE. Although his initial postoperative course was favorable, he subsequently presented with worsening voiding dysfunction. Imaging revealed a soft tissue mass with surface calcification obstructing the bladder neck. Cystoscopy identified a calcified mass adherent to the bladder neck, and endoscopic removal of the underlying necrotic tissue resulted in rapid improvement of urinary symptoms.

This case highlights a rare but significant complication of WAVE. Clinicians should consider the possibility of bladder outlet obstruction due to necrotic tissue extrusion in patients with delayed postoperative urinary symptoms.

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