University of Trieste, Ospedali riuniti di Trieste, Trieste, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Division of Oncology, Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
J Urol. 2017 Apr;197(4):1108-1114. doi: 10.1016/j.juro.2016.08.114. Epub 2016 Sep 8.
We report a comparative analysis of robotic assisted simple prostatectomy vs holmium laser enucleation of the prostate in patients who had benign prostatic hyperplasia with a large volume prostate (greater than 100 ml).
A total of 81 patients underwent robotic assisted simple prostatectomy and 45 underwent holmium laser enucleation of the prostate in a 7-year period. Patients were preoperatively assessed with transrectal ultrasound and uroflowmetry. Functional parameters were assessed postoperatively during followup. Perioperative outcomes included operative time, postoperative hemoglobin, catheterization time and hospitalization. Complications were reported according to the Clavien-Dindo classification.
Compared to the holmium laser enucleation group, patients treated with prostatectomy were significantly younger (median age 69 vs 74 years, p = 0.032) and less healthy (Charlson comorbidity index 2 or greater in 62% vs 29%, p = 0.0003), and had a lower rate of suprapubic catheterization (23% vs 42%, p = 0.028) and a higher preoperative I-PSS (International Prostate Symptom Score) (25 vs 21, p = 0.049). Both groups showed an improvement in the maximum flow rate (15 vs 11 ml per second, p = 0.7), and a significant reduction in post-void residual urine (-73 vs -100 ml, p = 0.4) and I-PSS (-20 vs -18, p = 0.8). Median operative time (105 vs 105 minutes, p = 0.9) and postoperative hemoglobin (13.2 vs 13.8 gm/dl, p = 0.08) were similar for robotic assisted prostatectomy and holmium laser enucleation, respectively. Median catheterization time (3 vs 2 days, p = 0.005) and median hospitalization (4 vs 2 days, p = 0.0001) were slightly shorter in the holmium laser group. Complication rates were similar with no Clavien grade greater than 3 in either group.
Our results from a single center suggest comparable outcomes for robotic assisted simple prostatectomy and holmium laser enucleation of the prostate in patients with a large volume prostate. These findings require external validation at other high volume centers.
我们报告了机器人辅助单纯前列腺切除术与钬激光前列腺剜除术治疗大体积前列腺良性前列腺增生（前列腺体积大于 100ml）患者的对比分析。
在 7 年期间，共有 81 例患者接受了机器人辅助单纯前列腺切除术，45 例患者接受了钬激光前列腺剜除术。术前通过经直肠超声和尿流率检查进行评估。在随访期间评估术后功能参数。围手术期结果包括手术时间、术后血红蛋白、导尿管留置时间和住院时间。并发症根据 Clavien-Dindo 分类报告。
与钬激光前列腺剜除组相比，前列腺切除术组患者明显更年轻（中位年龄 69 岁比 74 岁，p=0.032）且健康状况较差（62%患者 Charlson 合并症指数为 2 或更高，而 29%患者为 2 或更高，p=0.0003），耻骨上导尿管留置率较低（23%比 42%，p=0.028），术前国际前列腺症状评分（I-PSS）较高（25 分比 21 分，p=0.049）。两组的最大尿流率均有所改善（15ml/s 比 11ml/s，p=0.7），且残余尿量（-73ml 比-100ml，p=0.4）和 I-PSS（-20 分比-18 分，p=0.8）均显著降低。机器人辅助前列腺切除术和钬激光前列腺剜除术的中位手术时间（105 分钟比 105 分钟，p=0.9）和术后血红蛋白（13.2g/dl 比 13.8g/dl，p=0.08）相似。耻骨上导尿管留置时间（3 天比 2 天，p=0.005）和住院时间（4 天比 2 天，p=0.0001）在钬激光组略短。两组均无大于 3 级的 Clavien 分级并发症。
我们的单中心研究结果表明，机器人辅助单纯前列腺切除术和钬激光前列腺剜除术治疗大体积前列腺患者的效果相当。这些发现需要在其他高容量中心进行外部验证。
