Boston University School of Medicine, VA Boston Healthcare System, West Roxbury, Massachusetts, USA.
J Endourol. 2010 Oct;24(10):1655-8. doi: 10.1089/end.2010.0021.
Holmium laser enucleation of the prostate (HoLEP) is an excellent surgical treatment for patients with benign prostatic hyperplasia, but surgical complications are not well described. We set out to determine the predictors of stress incontinence (SUI) after HoLEP during the learning curve.
A retrospective review of our institution's HoLEP database was performed. Patients were divided into two groups: No pads at 3 months (group 1); SUI and/or mixed incontinence necessitating ≥ one pad at 3 months (group 2).
Seventy-seven patients underwent HoLEP at our institution. Nine (12%) were excluded for pure urge symptoms and two (3%) were lost to follow-up, leaving 66 total patients. No differences were noted as regards age (P = 0.54), operating room time (P = 0.18), prostate size (P = 0.85), prostate-specific antigen level (P = 0.96), or International Prostate Symptom Score (P = 0.11). The number of days between cases, however, was higher in group 2 (44.5 vs 18.1, P = 0.02) and was associated with SUI in simple logistic regression models (odds ratio [OR] 1.25; 95% confidence interval [CI]: 1.04-1.51; P = 0.019). As the interval time between cases increased from 1, 3, and 5 weeks, the strength of the association increased (1 week: OR 2.75; 95% CI: 0.78-9.66; P = 0.12; 3 weeks: OR 2.86; 95% CI: 0.92-8.91; P = 0.07; 5 weeks: OR 4.69; 95% CI: 1.21-18.26; P = 0.026). SUI resolved in all but two patients by 1 year.
The major associated risk for SUI, a complication presumably related to surgical technique, was prolonged duration between cases. During the learning curve, surgeons should schedule patients frequently to enhance learning and decrease time to mastery of the technique, thereby reducing SUI.
钬激光前列腺剜除术（HoLEP）是治疗前列腺增生的一种极好的手术方法，但手术并发症尚未得到很好的描述。我们旨在确定 HoLEP 学习曲线中并发压力性尿失禁（SUI）的预测因素。
对我院 HoLEP 数据库进行回顾性分析。患者分为两组：术后 3 个月无需使用尿垫（第 1 组）；术后 3 个月需要使用≥1 片尿垫治疗 SUI 和/或混合性尿失禁（第 2 组）。
我院共 77 例患者接受 HoLEP 治疗。9 例（12%）患者因单纯急迫症状而被排除，2 例（3%）患者失访，共 66 例患者纳入本研究。两组患者年龄（P = 0.54）、手术室时间（P = 0.18）、前列腺体积（P = 0.85）、前列腺特异抗原水平（P = 0.96）和国际前列腺症状评分（P = 0.11）均无差异。但第 2 组的病例间隔天数较高（44.5 天 vs 18.1 天，P = 0.02），且简单逻辑回归模型显示该间隔天数与 SUI 相关（比值比[OR] 1.25；95%置信区间[CI]：1.04-1.51；P = 0.019）。当病例间隔时间从 1 周、3 周和 5 周增加时，相关性强度增加（1 周：OR 2.75；95% CI：0.78-9.66；P = 0.12；3 周：OR 2.86；95% CI：0.92-8.91；P = 0.07；5 周：OR 4.69；95% CI：1.21-18.26；P = 0.026）。所有患者除 2 例外，SUI 均在 1 年内缓解。
SUI 的主要相关风险因素是手术间隔时间较长，这可能与手术技术相关。在学习曲线期间，外科医生应频繁安排患者就诊，以提高学习效果，缩短掌握技术的时间，从而降低 SUI 的发生风险。
