Hirayama Takahiro, Shitara Toshiya, Fujita Tetsuo, Iwamura Masatsugu, Kubo Seiichi, Baba Shiro
Department of Urology, Fuchinobe General Hospital.
Hinyokika Kiyo. 2010 Aug;56(8):431-4.
Holmium laser enucleation of the prostate (HoLEP) is a safe and effective treatment for patients with symptomatic benign prostatic hyperplasia (BPH), but is a difficult operation. To shorten the learning curve, we evaluated the surgical outcome of successive bilateral lobe enucleations with HoLEP. Performed by an inexperienced endourologist and an expert. Between March and July on 2009, we evaluated 20 cases of HoLEP performed by a beginner who underwent successive bilateral lobe enucleations and 20 cases of HoLEP performed by an expert. Enucleation time was shortened when successive bilateral lobe enucleations were performed by the beginner using HoLEP (115 vs 92 minutes, p<0.05). The enucleation time was significantly shorter in the expert group than in the beginner group. However, there were no significant differences in morcellation time, enucleated tissue weight, hemoglobin decrease level, sodium decrease level, catheterization time or significant incontinence time between the two groups. The postoperative evaluations was excellent in both groups. We conclude that HoLEP is a safe and effective operation. However, close supervision by an expert is required. In addition, learning from the easier part of enucleation to elaborate skill sets required to perform HoLEP is prerequisite for success.
钬激光前列腺剜除术（HoLEP）对于有症状的良性前列腺增生（BPH）患者是一种安全有效的治疗方法，但却是一项难度较大的手术。为缩短学习曲线，我们评估了采用HoLEP进行连续双侧叶剜除术的手术效果。手术由一位经验不足的泌尿外科医生和一位专家完成。在2009年3月至7月期间，我们评估了一位初学者采用HoLEP进行连续双侧叶剜除术的20例病例以及一位专家进行的20例HoLEP病例。初学者采用HoLEP进行连续双侧叶剜除术时，剜除时间缩短（115分钟对92分钟，p<0.05）。专家组的剜除时间明显短于初学者组。然而，两组在粉碎时间、剜除组织重量、血红蛋白降低水平、钠降低水平、导尿时间或重度尿失禁时间方面均无显著差异。两组术后评估均为优秀。我们得出结论，HoLEP是一种安全有效的手术。然而，需要专家密切监督。此外，从剜除术较容易的部分开始学习以完善进行HoLEP所需的技能组合是成功的先决条件。
