Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana 46202, USA.
J Urol. 2010 Mar;183(3):1105-9. doi: 10.1016/j.juro.2009.11.034. Epub 2010 Jan 21.
Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures.
From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively.
Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively.
Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results.
钬激光前列腺剜除术是治疗良性前列腺增生的一种现代方法。我们报告了超过 1000 例的经验。
从 1998 年 6 月至 2009 年 3 月，我们进行了 1065 例钬激光前列腺剜除术。在获得机构审查委员会批准后，我们回顾了数据库。报告的短期、中期和长期结果分别为 0 至 6、6 至 12 和 12 个月以上。
50 例（4.7%）患者存在膀胱结石，87 例（12.1%）有实验室研究结果的患者存在肾功能不全。411 例（38.7%）术前存在尿潴留。8 例和 16 例患者分别有明显的术前应激性和急迫性尿失禁。经直肠超声前列腺体积平均为 99.3 克（范围 9 至 391）。术前美国泌尿外科学会症状评分平均为 20.3（范围 1 至 35），最大尿流率为 8.4 毫升/秒（范围 1.1 至 39.3）。术中或术后并发症发生在 24 例（2.3%）。平均随访时间为 287 天（范围 6 至 3571）。在短期、中期和长期随访中，平均症状评分分别为 8.7、5.9 和 5.3，最大尿流率分别为 17.9、19.5 和 22.7 毫升/秒。在最近的随访中，3 例（0.3%）患者出现尿潴留。1 例最大尿流率为 20 毫升/秒的患者因前列腺增生再出血需要第二次手术。9 例（0.9%）、11 例（1.3%）、4 例（1.3%）和 0 例患者出现尿道狭窄，0 例、7 例（0.8%）、4 例（1.3%）和 5 例（6.0%）患者出现膀胱颈挛缩，分别在短期、中期、长期和 5 年以上随访时。在最近的随访中，9 例和 6 例患者分别出现明显的压力性和急迫性尿失禁。
钬激光前列腺剜除术治疗良性前列腺增生安全有效。并发症发生率低，术后尿失禁和辅助治疗罕见，具有持久的长期效果。
