Soto-Mesa D, Amorín-Díaz M, Pérez-Arviza L, Fernández-Pello Montes S, Martín-Huéscar A
Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, España.
Servicio de Neurología, Fundación Hospital de Jove, Gijón, España.
Actas Urol Esp. 2015 Nov;39(9):535-45. doi: 10.1016/j.acuro.2015.03.005. Epub 2015 May 23.
Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy.
A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed.
Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P<.01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P<.001) and shorter surgical times (P<.001). Better surgical performance (P<.001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group.
In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique.
钬激光前列腺剜除术（HoLEP）是良性前列腺增生手术治疗中前列腺腺瘤切除术的一种替代方法。我们分析了该技术的学习曲线，并与前列腺腺瘤切除术进行了二次比较。
进行了一项回顾性比较研究，纳入了在我们中心进行的前100例HoLEP病例和最近50例耻骨后腺瘤切除术病例。我们收集了患者、手术、麻醉、围手术期变量、麻醉并发症和术后变量的数据，并进行了6个月的随访。我们分析了无指导者情况下HoLEP的学习曲线，并将HoLEP在两个不同阶段（学习阶段和稳定阶段）的特征与最近进行的耻骨后前列腺腺瘤切除术进行了比较。
硬膜内麻醉是最常用的技术。HoLEP的输血需求、住院时间（P<0.01）和术后发病率低于腺瘤切除术。然而，耻骨后腺瘤切除术组的初始前列腺体积较大（P<0.001），手术时间较短（P<0.001）。与HoLEP-A组相比，HoLEP-B组（一旦克服学习曲线）观察到更好的手术表现（P<0.001）和更低的并发症发生率。
在我们中心，HoLEP被引入作为开放性耻骨后腺瘤切除术的有效替代方法，在发病率和缩短住院时间方面取得了优异的效果。就学习曲线而言，我们认为大约50例患者（无指导者）是一个合适的界限。局部麻醉是麻醉技术的一个好选择。
