Intraperitoneal bladder perforation can rarely cause mechanical small-bowel obstruction. A man with benign prostatic hyperplasia and longstanding transurethral catheterisation presented with abdominal pain, distension, obstipation and vomiting. Computed tomography demonstrated small-bowel obstruction with an ileal transition point adjacent to the catheter tip traversing the bladder dome. Surgical exploration revealed an ileal loop adherent to the perforated bladder. Adhesiolysis relieved the obstruction, and the bladder defect was debrided and repaired in two layers. This case highlights the importance of assessing catheter position and bladder integrity on computed tomography in chronically catheterised patients presenting with bowel obstruction, enabling recognition and multidisciplinary management.

Large prostatic tumors are rare conditions that may present with atypical morphology on imaging studies and can pose substantial challenges in preoperative diagnosis. We encountered a case of giant multilocular prostatic cystadenoma (GMPC) with dorsal growth in which malignancy could not be excluded despite multiple biopsies demonstrating stromal hyperplasia. A 71-year-old man presented with lower abdominal pain associated with defecation, and imaging revealed a large pelvic mass with increased uptake on positron emission tomography. Because malignancy could not be excluded, radical prostatectomy was performed. The procedure was initiated robotically but required conversion to an open approach due to intraoperative difficulty. Histopathological examination of the 500-g resected mass revealed stromal hyperplasia with multilocular cystic architecture, consistent with GMPC. Postoperatively, urinary function remained satisfactory, and no recurrence has been observed to date. This case highlights the diagnostic challenges associated with GMPC presenting with atypical growth patterns and demonstrates that complete excision is feasible with an appropriate surgical approach.

Holmium laser enucleation of the prostate (HoLEP) is an established surgical treatment for benign prostatic hyperplasia (BPH). Although it is conventionally performed under general anaesthesia (GA), spinal anaesthesia (SA) may represent an important alternative for patients with significant medical comorbidity. We performed a systematic review and meta-analysis comparing peri-operative outcomes of HoLEP performed under GA versus SA. A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of electronic databases was performed (MEDLINE, PubMed, EMBASE and Google Scholar) for comparative studies evaluating GA versus SA for HoLEP. A random-effects meta-analysis was performed using mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CI). A search of electronic databases found four studies, enrolling a total of 2323 patients. SA was associated with a significantly shorter operative time than GA (P=0.03), although this finding was not robust on leave-one-out sensitivity analysis. There were no significant differences in resected tissue weight (P=0.73), Hb drop (P=0.07), post-operative catheter reinsertion (P=0.34), Clavien-Dindo grade ≥3 complications (P=0.14), change in IPSS (P=0.91), change in QMax (P=0.60), or change in PVR (P=1.00). Moderate to high heterogeneity was observed for several outcomes, and the available evidence was limited to retrospective and propensity-matched studies. Current evidence suggests that spinal anaesthesia could be a safe and effective alternative to general anaesthesia for HoLEP, with comparable intra- and post-operative outcomes. SA may expand access to HoLEP for patients at increased risk from GA. However, the available evidence remains limited, and high-quality prospective randomised studies are required to confirm these findings.