Rassweiler J, Roder M, Schulze M, Muschter R
Urologische Klinik, Klinkum Heilbronn, Am Gesundbrunnen 20, 74074 Heilbronn, Deutschland.
Urologe A. 2008 Apr;47(4):441-8. doi: 10.1007/s00120-008-1684-7.
To evaluate the efficacy and safety of an intermediate power (50 W) holmium:YAG laser system for transurethral enucleation of the prostate (TULP) with the use of a new mechanical morcellator. Our results are compared with the results of high-powered holmium laser enucleation (HoLEP) presented in the literature.
From December 2003 to January 2008, 129 patients with benign prostatic hyperplasia were treated by TULP. In 45 cases (group A; 2.0, 12 Hz) we used a bipolar resectoscope (VISTA/ACMI) for morcellation, whereas after that morcellation was accomplished with a modified endoscopic shaver (Wolf). Thirty-nine patients were treated using 25 W (group B; 2.0 J, 12 Hz), and 45 patients were treated using 40 W (group C; 2.2 J 18 Hz), who were compared with 45 matched-pair patients who received transurethral resection of the prostate (TURP; group D). Finally, the literature on HoLEP was reviewed.
Bipolar morcellation significantly prolonged the operating time (135 vs. 131 vs. 96 min). The morcellation speed averaged 2.8 (range 1.3-5.2) g/min with no complications. The resection speed (retrieval rate) of 40-W TULP was comparable to that for TURP (0.71 vs. 0.76 g/min). The transfusion rate was lower than for TURP (8% vs. 12%), with a smaller Hb difference (3.1 vs. 3.8 mg/dl). Catheter times (3.4 vs. 4.1 days) were similar; however, hospital stay was significantly shorter after TULP (5.2 vs. 6.8 days). The complication rate was significantly lower (6.6% vs. 13.3%). The efficacy of HoLEP significantly improved with introduction of the morcellator: Resection speed increased from 0.34-0.61 g/min to 0.48-0.82 g/min. HoLEP was better than 40-W TULP regarding transfusion rate (0-4% vs. 8%) and catheter time (1.1-1.5 vs. 3.4 days). Complications and functional results were similar. CONCLUSION[UBERSCHRIFT]: The intermediate-power 50-W holmium laser together with the new morcellator enable safe transurethral enucleation of the prostate. As with HoLEP, the procedure has a significant learning curve. The retrieval times of TULP are similar to those for HoLEP, but the risk of bleeding is higher. New modifications (i.e., thullium laser) will further improve the technique of laser enucleation.
评估使用新型机械粉碎器的中等功率（50瓦）钬：钇铝石榴石激光系统经尿道前列腺剜除术（TULP）的疗效和安全性。将我们的结果与文献中报道的高功率钬激光剜除术（HoLEP）的结果进行比较。
2003年12月至2008年1月，129例良性前列腺增生患者接受了TULP治疗。45例患者（A组；2.0焦耳，12赫兹）使用双极电切镜（VISTA/ACMI）进行粉碎，之后用改良的内镜刨削器（Wolf）完成粉碎。39例患者使用25瓦（B组；2.0焦耳，12赫兹）进行治疗，45例患者使用40瓦（C组；2.2焦耳，18赫兹）进行治疗，将这两组患者与45例接受经尿道前列腺切除术（TURP；D组）的配对患者进行比较。最后，对HoLEP的文献进行了综述。
双极粉碎显著延长了手术时间（135分钟对131分钟对96分钟）。粉碎速度平均为2.8（范围1.3 - 5.2）克/分钟，无并发症。40瓦TULP的切除速度（取出率）与TURP相当（0.71对0.76克/分钟）。输血率低于TURP（8%对12%），血红蛋白差异较小（3.1对3.8毫克/分升）。导尿管留置时间相似（3.4天对4.1天）；然而，TULP后的住院时间明显更短（5.2天对6.8天）。并发症发生率显著更低（6.6%对13.3%）。随着粉碎器的引入，HoLEP的疗效显著提高：切除速度从0.34 - 0.61克/分钟提高到0.48 - 0.82克/分钟。在输血率（0 - 4%对8%）和导尿管留置时间（1.1 - 1.5天对3.4天）方面，HoLEP优于40瓦TULP。并发症和功能结果相似。结论：中等功率50瓦钬激光与新型粉碎器可实现安全的经尿道前列腺剜除术。与HoLEP一样，该手术有明显的学习曲线。TULP的取出时间与HoLEP相似，但出血风险更高。新的改进（如铥激光）将进一步改善激光剜除技术。
