Kuntz Rainer M, Lehrich Karin, Ahyai Sascha
Department of Urology, Auguste Viktoria Hospital, Berlin, Germany.
J Endourol. 2004 Mar;18(2):183-8. doi: 10.1089/089277904322959842.
In conventional transurethral resection of the prostate (TURP), perioperative morbidity resulting from causes such as blood loss and TUR syndrome increases with prostate size. Therefore, TURP is restricted to small and medium-sized glands. The present study aimed to find out whether perioperative parameters of holmium laser enucleation of the prostate (HoLEP) other than operation time and weight of resected tissue were dependent on prostate size.
A total of 384 patients were treated with HoLEP (holmium:YAG laser, 2.0 J, 40 or 50 Hz, 80 or 100 W, 550-nm bare fiber) for acute removal of obstructing benign hyperplastic tissue. Among them, 111 patients (28.9%) had prostates of <40 g (group 1), 152 (39.6%) had prostates of 40 to 79 g (group 2), and 121 (31.5%) had prostates of >/=80 g (range 80-260) (group 3). The perioperative outcomes of the three groups were compared. A total of 346 patients completed the 1-month postoperative assessment.
The mean prostate sizes were 31.8 g, 56 g, and 98.7 g for groups 1, 2, and 3 (P<0.0001 group 1 v group 2 v group 3). The mean resected tissue weight was 19.5 g v 34.4 g (P= 0.009) v 70.1 g (range 50-220) (P< 0.0001). The mean operation time was 64.3 v 84.2 (P= 0.009) v 118.4 minutes (P< 0.0001). The mean hemoglobin loss was 0.9 v 1.2 (NS) v 1.9 g/dL (P< 0.001). The overall correlation between hemoglobin loss and prostate size in all patients was very weak (r = 0.229) and just exceeded the level of significance (r = 0.2). In all three groups, the median postoperative catheter time was 1 day, and the median postoperative hospital stay was 2 days. The HoLEP resulted in an immediate and significant improvement of American Urological Association Symptom Scores, peak urinary flow rates, and postvoiding residual urine volumes (P< 0.0001) 1 month after the operation, without significant differences between the groups. The rate of complications was similar in all three groups. None of the patients needed blood transfusions. There were no perioperative deaths.
In HoLEP, perioperative morbidity and postoperative micturition improvement do not depend on prostate size. Therefore, in contrast to TURP, HoLEP is equally suitable for small, medium-size, and large prostate glands.
在传统经尿道前列腺切除术（TURP）中，因失血和TUR综合征等原因导致的围手术期发病率会随着前列腺体积增大而增加。因此，TURP仅适用于中小体积腺体。本研究旨在探究除手术时间和切除组织重量外，前列腺钬激光剜除术（HoLEP）的围手术期参数是否取决于前列腺体积。
共有384例患者接受HoLEP（钬：钇铝石榴石激光，2.0 J，40或50 Hz，80或100 W，550 nm裸光纤）治疗以急性切除梗阻性良性增生组织。其中，111例患者（28.9%）前列腺重量<40 g（第1组），152例（39.6%）前列腺重量为40至79 g（第2组），121例（31.5%）前列腺重量≥80 g（范围80 - 26０g）（第3组）。比较三组的围手术期结果。共有346例患者完成了术后1个月的评估。
第1、2、3组的平均前列腺体积分别为31.8 g、56 g和98.7 g（第1组与第2组与第3组比较，P<0.0001）。平均切除组织重量分别为19.5 g对34.4 g（P = 0.009）对70.1 g（范围50 - 220）（P<0.0001）。平均手术时间分别为64.3对84.2（P = 0.009）对118.4分钟（P<0.0001）。平均血红蛋白损失分别为0.9对1.2（无显著差异）对1.9 g/dL（P<0.001）。所有患者中血红蛋白损失与前列腺体积的总体相关性非常弱（r = 0.229），且刚刚超过显著水平（r = 0.2）。在所有三组中，术后导尿管留置时间中位数为1天，术后住院时间中位数为2天。HoLEP术后1个月时美国泌尿外科学会症状评分、最大尿流率和残余尿量立即得到显著改善（P<0.0001），且组间无显著差异。三组并发症发生率相似。所有患者均无需输血。无围手术期死亡病例。
在HoLEP中，围手术期发病率和术后排尿改善情况不取决于前列腺体积。因此，与TURP不同，HoLEP同样适用于小、中、大体积前列腺腺体。
