Vincent Michael W, Gilling Peter J
Department of Urology, Tauranga Hospital, Tauranga, New Zealand,
World J Urol. 2015 Apr;33(4):487-93. doi: 10.1007/s00345-014-1443-x. Epub 2014 Nov 22.
Lower urinary tract symptoms (LUTS) are a common complaint and although can be adequately managed with medication, surgery remains the mainstay of treatment. Transurethral resection has been the reference 'gold standard', but due to its complications and issues with larger volume prostates, many alternatives have been developed and assessed. Holmium laser enucleation of the prostate (HoLEP) has shown excellent efficacy, durability and safety and has become an important alternative that has gained guideline approval.
HoLEP has been shown to have outcomes that are equivalent or better than TURP in both urodynamic measurements and symptom scores. Its outcomes have been proven to be durable and cost-effective. HoLEP has fewer and less serious complications when compared to the current reference standard, its use also allows earlier removal of catheter and hospital discharge. Appropriate mentoring reduces many of the issues associated with the steep learning curve, thus removing the main hurdle to its widespread adoption as the surgical treatment of choice for LUTS due to benign prostatic hyperplasia (BPH).
HoLEP fulfils all of the requirements as an alternative/replacement for TURP and open prostatectomy, with equivalent outcomes and reduced complications. With improvements in the learning curve, it could now be considered the true gold standard surgical treatment for BPH. HoLEP has come of age.
下尿路症状（LUTS）是一种常见的病症，尽管药物治疗可以对其进行充分管理，但手术仍然是主要的治疗方法。经尿道切除术一直是参考的“金标准”，但由于其并发症以及对于体积较大前列腺的处理问题，人们已经开发并评估了许多替代方法。钬激光前列腺剜除术（HoLEP）已显示出卓越的疗效、耐用性和安全性，并已成为一项获得指南认可的重要替代方法。
在尿动力学测量和症状评分方面，HoLEP已被证明具有与经尿道前列腺电切术（TURP）相当或更好的结果。其结果已被证明具有持久性且具有成本效益。与当前的参考标准相比，HoLEP的并发症更少且更不严重，其应用还允许更早拔除导尿管并出院。适当的指导可以减少许多与陡峭学习曲线相关的问题，从而消除了其作为良性前列腺增生（BPH）所致LUTS的首选手术治疗方法广泛应用的主要障碍。
HoLEP满足作为TURP和开放性前列腺切除术的替代/取代方法的所有要求，具有相当的结果且并发症减少。随着学习曲线的改善，现在可以认为它是BPH真正的金标准手术治疗方法。HoLEP已经成熟。
