Marien Tracy, Kadihasanoglu Mustafa, Tangpaitoon Teerayut, York Nadya, Blackburne Andrew T, Abdul-Muhsin Haidar, Borofsky Michael S, Krambeck Amy E, Humphreys Mitchell R, Lingeman James E, Miller Nicole L
Vanderbilt University Medical Center, Nashville, Tennessee.
Indiana University School of Medicine, Indianapolis, Indiana.
J Urol. 2017 Jun;197(6):1517-1522. doi: 10.1016/j.juro.2016.12.098. Epub 2016 Dec 30.
Holmium laser enucleation of the prostate can also be applied in the re-treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re-treatment setting.
We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re-treatment and primary holmium laser enucleation of the prostate.
Of the 360 of 2,242 men (16%) who underwent re-treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re-treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re-treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re-treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7% vs 1.8%, p = 0.01) and urethral stricture (3.3% vs 1.5%, p = 0.043) was slightly higher in the re-treatment group.
Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re-treatment setting were no different from those in the primary setting. While re-treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.
当其他良性前列腺增生治疗方法失败时，钬激光前列腺剜除术也可应用于再次治疗的情况。我们比较了在初次治疗与再次治疗情况下接受钬激光前列腺剜除术的男性患者的治疗结果。
我们回顾性分析了2003年至2015年间在4家学术医院接受钬激光前列腺剜除术的2242例患者的记录。比较了再次治疗组和初次钬激光前列腺剜除术组患者的人口统计学资料、手术及围手术期结果。
在2242例接受再次钬激光前列腺剜除术的男性患者中，有360例（16%），其中71%的手术是针对残余尿路症状进行的。最常见的初次手术是经尿道前列腺切除术，占42%的病例。上次良性前列腺增生手术与再次治疗之间的平均时间为68个月（范围1至444个月）。两组患者在年龄、前列腺大小、美国泌尿外科学会（AUA）症状评分或平均尿流率方面无显著差异。围手术期，再次钬激光前列腺剜除术的手术时间明显缩短、失血减少、标本重量减轻且住院时间缩短。两组患者的AUA症状评分均有所改善，但再次治疗的男性患者评分仍较高（6.5对5.0，p<0.001）。再次治疗组的血块潴留可能性（4.7%对1.8%，p = 0.01）和尿道狭窄可能性（3.3%对1.5%，p = 0.043）略高。
在再次治疗情况下进行的钬激光前列腺剜除术的围手术期即时结果与初次治疗情况无异。虽然再次治疗与血块潴留、尿道狭窄可能性增加及AUA症状评分较高有关，但必须将这些微小差异与两组总体良好的症状改善情况相权衡。
