Li Pu, Wang Chengming, Cao Qiang, Zhang Jiexiu, Shi Haibin, Meng Xiaoxin
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Urol Int. 2017;99(4):422-428. doi: 10.1159/000478788. Epub 2017 Aug 3.
This study was aimed at reporting the initial experience with prostatic arterial embolization (PAE) followed by holmium laser enucleation of the prostate (HoLEP) as a planned combined approach for extremely enlarged benign prostate hyperplasia (BPH), and retrospectively estimating the efficacy and safety of this novel technique.
Twenty-four BPH patients who underwent PAE and subsequent HoLEP were included. The PAE procedure was performed under local anesthesia at the supine position with polyvinyl alcohol spherical particles and gelatin sponge particles. HoLEP was performed 3 months after PAE by the "en-bloc" enucleation technique. Clinical data before and 6 months after the procedure were analyzed.
PAE and HoLEP were technically successful in all 24 patients. The mean prostate volume was 219 ± 38 mL; the mean total operative time and enucleation time for HoLEP were 117.8 ± 21.9 and 83.5 ± 15.4 min, respectively; and the mean resected prostate weight was 118.3 ± 20.7 g. No transurethral resection of the prostate syndrome was observed during and after HoLEP. The estimated blood loss during HoLEP was 72.1 ± 33.7 mL, and no case required transfusion. International Prostate Symptom Score and post void residual volume decreased significantly (24.1 ± 2.84 vs. 13.5 ± 3.39, p < 0.001; 107.1 ± 40.8 vs. 21.8 ± 16.8, p < 0.001, respectively), maximal flow rate increased significantly (6.25 ± 1.42 vs. 17.63 ± 16.56, p < 0.001), and prostatic specific antigen level also decreased after the procedure (9.29 ± 2.28 vs. 4.99 ± 1.35, p < 0.001).
PAE followed by HoLEP as a planned combined approach can be performed safely, feasibly, and efficiently in patients with extremely enlarged BPH.
本研究旨在报告前列腺动脉栓塞术（PAE）联合钬激光前列腺剜除术（HoLEP）作为一种针对极度增大的良性前列腺增生（BPH）的计划性联合治疗方法的初步经验，并回顾性评估这种新技术的疗效和安全性。
纳入24例接受PAE及后续HoLEP的BPH患者。PAE手术在局部麻醉下于仰卧位进行，使用聚乙烯醇球形颗粒和明胶海绵颗粒。PAE术后3个月采用“整块”剜除技术进行HoLEP。分析术前及术后6个月的临床数据。
24例患者的PAE和HoLEP技术均成功。平均前列腺体积为219±38 mL；HoLEP的平均总手术时间和剜除时间分别为117.8±21.9分钟和83.5±15.4分钟；平均切除前列腺重量为118.3±20.7 g。HoLEP术中及术后未观察到经尿道前列腺电切综合征。HoLEP术中估计失血量为72.1±33.7 mL，无一例需要输血。国际前列腺症状评分和残余尿量显著降低（分别为24.1±2.84对13.5±3.39，p<0.001；107.1±40.8对21.8±16.8，p<0.001），最大尿流率显著增加（6.25±1.42对17.63±16.56，p<0.001），术后前列腺特异性抗原水平也降低（9.29±2.28对4.99±1.35，p<0.001）。
PAE联合HoLEP作为一种计划性联合治疗方法，可在极度增大的BPH患者中安全、可行且有效地实施。
