title: [Risk of rectal perforation during intention to treat laser photovaporization of prostate with transrectal ultrasound guidance: a report of 4 cases].
abstract: BACKGROUND
  Transrectal ultrasound guidance (TUG) during prostate endoscopic surgery can optimize the procedure by reducing the risk of capsular perforation and ascertain the treatment completeness. TUG is proposed during photoselective vaporisation of prostate (PVP).
  
  
  OBJECTIVE
  To report four cases of rectal perforations during PVP with TUG and assess their occurrence.
  
  
  METHODS
  This is a retrospective study including prostate endoscopic surgeries with TUG, performed in two centers between November 2011 and May 2013. Rectal perforations were identified. Surgical data, treatment modalities and postoperative outcomes of rectal perforations were analysed.
  
  
  RESULTS
  Four rectal perforations were identified among 450 surgical procedures. Median age and prostate volume were 80 years old [62-91] and 40mL [13-150], respectively. Two perforations occurred during PVP with Greenlight(®) XPS 180W. Two perforations occurred during transurethral resection of prostate or cervicoprostatic incision. Patients were treated by systematic urinary drainage associated with colostomy or direct suture. Two patients died from this complication and two patients have satisfying functional outcomes at one year.
  
  
  CONCLUSIONS
  TUG during prostate endoscopic surgery could lead to rectal perforation by protusion of the prostate and therefore should be used cautiously.
  
  
  METHODS
  5.
authors.affiliation: Service d'urologie, CHU Pontchaillou, 2, avenue Henri-Le-Guilloux, 35033 Rennes, France. Electronic address: tfardoun@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Fardoun
authors.affiliation: Service d'urologie, CHU Pontchaillou, 2, avenue Henri-Le-Guilloux, 35033 Rennes, France.
authors.forename: R
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Service d'urologie, CHU Pontchaillou, 2, avenue Henri-Le-Guilloux, 35033 Rennes, France.
authors.forename: S
authors.initials: S
authors.lastname: Vincendeau
authors.affiliation: Service d'urologie, polyclinique du Littoral, 58, rue La-Fayette, 22003 St-Brieuc, France.
authors.forename: E
authors.initials: E
authors.lastname: Della Negra
authors.affiliation: Service d'urologie, polyclinique du Littoral, 58, rue La-Fayette, 22003 St-Brieuc, France.
authors.forename: L
authors.initials: L
authors.lastname: Corbel
authors.affiliation: Service d'urologie, CHU Pontchaillou, 2, avenue Henri-Le-Guilloux, 35033 Rennes, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Couapel
authors.affiliation: Service d'urologie, CHU Pontchaillou, 2, avenue Henri-Le-Guilloux, 35033 Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Manunta
authors.affiliation: Service d'urologie, CHU Pontchaillou, 2, avenue Henri-Le-Guilloux, 35033 Rennes, France.
authors.forename: K
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: Service d'urologie, CHU Pontchaillou, 2, avenue Henri-Le-Guilloux, 35033 Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Verhoest
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D057194:Intention to Treat Analysis; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012007:Rectum / Q000293:injuries*; D012189:Retrospective Studies; D018570:Risk Assessment; D020728:Transurethral Resection of Prostate / Q000009:adverse effects*
keywords: Benign prostatic hyperplasia; Chirurgie endoscopique; Complications peropératoires; Complications post-opératoires; Endoscopic surgery; Hypertrophie bénigne de prostate; Intraoperative complication; Laser; Morbidity; Morbidité; Photoselective vaporization; Photovaporisation; Postoperative complication