Kuntz Rainer M, Lehrich Karin, Ahyai Sascha
Department of Urology, Auguste Viktoria Hospital, Berlin, Germany.
J Endourol. 2004 Mar;18(2):189-91. doi: 10.1089/089277904322959851.
This ongoing randomized study aims to find out whether transurethral holmium laser enucleation of the prostate (HoLEP) could be an alternative to open transvesical prostatectomy in patients with prostates >100 g.
A series of 120 urodynamically obstructed patients were randomized to HoLEP or open prostatectomy, 60 patients to each group. The HoLEP was performed with high-powered Ho:YAG lasers at 80 to 100 W (2.0 J, 40-50 Hz) and 550-nm bare laser fibers. The American Urological Association Symptom Scores, peak urinary flow rates, and postvoiding residual urine volumes were evaluated preoperatively and at 1, 3, 6, 12, and 18 months postoperatively. All complications were noted.
By the Mann-Whitney test, there was no significant difference between the HoLEP and open surgery groups in patient age (69.0 years HoLEP v 71.0 years open surgery), prostate volume (115 cc [range 100-230 cc] v 113 cc [100-230 cc], or weight of resected tissue (94 g [range 57-220 g] v 96 g [range 61-220 g]). There were significant differences in the mean operative time (136 v 91 minutes; P< 0.0001), mean hemoglobin loss (1.9 v 2.8 g/dL; P< 0.0001), median catheter time (1 day v 6 days; P< 0.0001), and median hospital stay (2 days v 10 days; P< 0.0001). Both HoLEP and open prostatectomy resulted in pronounced and lasting postoperative improvements in Symptom Scores, peak urinary flow rates, and postvoiding residual volumes (P< 0.0001). The differences between HoLEP and open prostatectomy were not significant at any interval for any parameter. Blood transfusions were required in 0 HoLEP patients v 8 open surgery patients. Arterial bleeding occurred in three patients in each group. Secondary apical resection was required in two HoLEP patients and no open surgery patients. Bladder neck contracture occurred in none of the HoLEP patients and two of those having open surgery. Thus, the total number of patients having complications was 7 with HoLEP and 13 with open surgery. There were no deaths in either group.
The HoLEP appears to be an endourologic alternative to open surgical enucleation of the prostate for large glands. It entails significantly less blood loss and a much shorter catheter time and hospital stay. The perioperative outcome strongly favors the holmium procedure. The rate of late complications is equally low with each procedure. The postoperative micturition improvement was significant and lasting and was equivalent in the two groups.
这项正在进行的随机研究旨在确定对于前列腺重量超过100 g的患者，经尿道钬激光前列腺剜除术（HoLEP）是否可替代开放性经膀胱前列腺切除术。
120例存在尿动力学梗阻的患者被随机分为HoLEP组或开放性前列腺切除术组，每组60例。HoLEP手术使用功率为80至100 W（2.0 J，40 - 50 Hz）且波长为550 nm的裸激光光纤的高功率钬：钇铝石榴石激光进行。术前以及术后1、3、6、12和18个月评估美国泌尿外科学会症状评分、最大尿流率和排尿后残余尿量。记录所有并发症。
通过曼 - 惠特尼检验，HoLEP组和开放性手术组在患者年龄（HoLEP组69.0岁，开放性手术组71.0岁）、前列腺体积（115 cc[范围100 - 230 cc]对113 cc[100 - 230 cc]）或切除组织重量（94 g[范围57 - 220 g]对96 g[范围61 - 220 g]）方面无显著差异。在平均手术时间（136对91分钟；P < 0.0001）、平均血红蛋白丢失量（1.9对2.8 g/dL；P < 0.0001）、中位导尿管留置时间（1天对6天；P < 0.0001）和中位住院时间（2天对10天；P < 0.0001）方面存在显著差异。HoLEP和开放性前列腺切除术均使症状评分、最大尿流率和排尿后残余尿量在术后有显著且持久的改善（P < 0.0001）。HoLEP和开放性前列腺切除术在任何时间点对于任何参数的差异均不显著。HoLEP组0例患者需要输血，开放性手术组8例患者需要输血。每组各有3例患者发生动脉出血。HoLEP组有2例患者需要进行二次尖部切除，开放性手术组无患者需要。HoLEP组无患者发生膀胱颈挛缩，开放性手术组有2例患者发生。因此，HoLEP组有并发症的患者总数为7例，开放性手术组为13例。两组均无死亡病例。
对于大腺体前列腺，HoLEP似乎是开放性手术前列腺剜除术的一种腔内泌尿外科替代方法。它导致的失血量显著减少，导尿管留置时间和住院时间大大缩短。围手术期结果强烈支持钬激光手术。两种手术的晚期并发症发生率同样低。两组术后排尿改善均显著且持久，且效果相当。
