Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana 46202, USA.
J Endourol. 2010 Mar;24(3):433-7. doi: 10.1089/end.2009.0147.
Open simple prostatectomy has been considered the treatment of choice for symptomatic benign prostatic hyperplasia (BPH) of large prostates because traditional endoscopic techniques have not proven either effective or feasible. We present our experience with holmium laser enucleation of the prostate (HoLEP) for glands >175 cc.
An Institutional Review Board approved prospective database has been maintained since January 1999 for all HoLEP procedures. The database was reviewed retrospectively for patients who underwent HoLEP for BPH with a preoperative transrectal ultrasonography (TRUS) volume of >175 cc.
From January 1999 to November 2008, we identified 57 patients with a mean pretreatment TRUS volume of 217.8 cc (range 175-391 cc). Preoperative retention was present in 30 patients. Preoperative mean prostate-specific antigen level was 14.6 ng/mL, mean American Urological Association (AUA) symptom index was 19.0, and mean peak flow (Qmax) was 8.2 mL/sec. Mean hospital stay was 26 hours, and postoperative catheterization was 18.5 hours (range 6-96 hrs). All patients were able to void after catheter removal. Mean enucleated tissue weight was 176.4 g (range 48-532.2 g). At 6-month follow-up, AUA symptom index was 6.5, mean PSA level was 0.78 ng/mL, and Qmax was 18.5. During the follow-up period, no patient needed catheterization or had persistent incontinence.
Even in the large prostate gland, HoLEP provides a satisfactory outcome with low morbidity. HoLEP is the only endoscopic technique that allows for tissue removal comparable to that of open prostatectomy for such patients.
开放式单纯前列腺切除术已被认为是治疗大前列腺症状性良性前列腺增生（BPH）的首选方法，因为传统的内镜技术既没有被证明是有效或可行的。我们介绍了我们在前列腺钬激光剜除术（HoLEP）治疗 >175cc 腺体方面的经验。
自 1999 年 1 月以来，我们为所有 HoLEP 手术维护了一个机构审查委员会批准的前瞻性数据库。我们对接受 HoLEP 治疗 BPH 且术前经直肠超声（TRUS）体积 >175cc 的患者的数据库进行了回顾性分析。
从 1999 年 1 月到 2008 年 11 月，我们共发现 57 例患者，平均术前 TRUS 体积为 217.8cc（范围 175-391cc）。术前有 30 例存在尿潴留。术前平均前列腺特异性抗原（PSA）水平为 14.6ng/ml，平均美国泌尿外科学会（AUA）症状指数为 19.0，平均最大尿流率（Qmax）为 8.2ml/sec。平均住院时间为 26 小时，术后导尿管留置时间为 18.5 小时（范围 6-96 小时）。所有患者在去除导尿管后均可自行排尿。平均切除的组织重量为 176.4g（范围 48-532.2g）。在 6 个月的随访中，AUA 症状指数为 6.5，平均 PSA 水平为 0.78ng/ml，Qmax 为 18.5。在随访期间，没有患者需要再次导尿或出现持续性尿失禁。
即使在大前列腺中，HoLEP 也能提供令人满意的结果，且发病率低。HoLEP 是唯一一种允许对这些患者进行与开放式前列腺切除术相当的组织切除的内镜技术。
