Editorial Comment for Sharib et al.

I agree with the authors that it is very critical to report any adverse events and particularly serious adverse events, such as the ones reported here. The development of panurethral strictures or contracted bladder necessitating urinary diversion after GreenLight™ laser vaporization of the prostate has not been reported before. We have to keep in mind, however, that two of the three cases reported here necessitated additional procedures using other sources of energy, such as vaportrode vaporization and hemostasis or performing a regular transurethral resection of the prostate (TURP) after failure of the primary treatment although the stricture was noted before the TURP. The third case, however, did not have any other source of energy used except the GreenLight.

Panurethral strictures and particularly contracted bladder are not recognized complications associated with the use of monopolar diathermy sources. This would still raise a flag that GreenLight energy could be associated with urethral or bladder injury, particularly in cases needing more time.

The explanation of such disastrous events is not obvious. The only reasonable explanations would be that the irrigating fluid leaking around the continuous flow scope became hostile either by increased temperature or chemical toxins modifying the pH in a significant way during vaporization by the GreenLight and in these cases, somehow these changes could be more manifest for whatever reason. The contracted bladder complication could be secondary to the same mechanism but also possibly secondary to a broken fiber becoming end firing, vaporizing the bladder wall. Evaluating the irrigating fluid could be an interesting subject for research.

Again, I would like to encourage everybody to report their complications for all of us to benefit and to protect our patients if we can identify the causes and provide corrective measures.