Simultaneous endoscopic management of prostatic and seminal vesicle abscess using holmium laser enucleation of the prostate and seminal vesiculoscopy: a case series.

BACKGROUND: Prostatic abscess (PA) is uncommon but potentially life-threatening. Secondary seminal vesicle abscess (SVA) is extremely rare and lacks standardized minimally invasive treatment. We report a case series evaluating holmium laser enucleation of the prostate (HoLEP) and seminal vesiculoscopy for the simultaneous drainage of these abscesses via a single endoscopic access. CASE PRESENTATION: Two Han-Chinese men (aged 82 and 56 years) presented with LUTS, fever and imaging-confirmed PA; the younger also had a multi-loculated right SVA. The prostate volumes were approximately 75 mL (Case 1) and 50 mL (Case 2). The prostatic abscesses measured 33 × 34 mm (Case 1) and 27 × 15 mm (Case 2), with the right seminal vesicle abscess measuring 40 × 24 mm (Case 2). After culture-directed antibiotics and glycemic control, both patients underwent single-session endoscopic surgery: Case 1 HoLEP alone; Case 2 seminal vesiculoscopy followed immediately by HoLEP. Operative times were 50 minutes and 60 minutes; blood loss < 50 mL. No intraoperative or major postoperative complications were encountered (transient stress urinary incontinence in Case 1 resolved spontaneously within 1 week). Catheters were removed on postoperative days 5 and 4; Qmax improved to 20 mL/second and 22 mL/second and IPSS fell from 25 to 9 and 26 to 8 at 1 month. Imageological examination at 1 month showed complete resolution of abscess cavities with no recurrence. CONCLUSIONS: HoLEP appears to be a viable option for PA drainage and simultaneous relief of bladder-outlet obstruction. Combined HoLEP plus seminal vesiculoscopy may offer a feasible, single-access minimally invasive strategy for complex prostatovesicular abscesses, though long-term follow-up is necessary to definitively confirm efficacy and recurrence rates.