1 Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia.
2 Department of Urology, University of California, Irvine, California.
J Endourol. 2019 Jan;33(1):16-21. doi: 10.1089/end.2018.0791.
The objective of this study was to assess the efficacy and safety of novel thulium fiber laser enucleation of the prostate (ThuFLEP) vs conventional open simple retropubic prostatectomy (OP) for large volume benign prostatic hyperplasia (BPH).
We performed a retrospective review of patients who underwent surgical treatment for large volume BPH (>80 cc) from 2015 to 2017. Preoperative patient examination included the assessment of functional parameters: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Q), and postvoid residual urine volume. The hemoglobin level was measured before and after the operation.
A total of 130 patients were included in the study. Of these, 40 patients underwent OP, and 90 patients underwent ThuFLEP. Groups were similar in terms of preoperative functional parameters (IPSS, QoL, and Q). The mean operative time was comparable for both procedures (p = 0.285) as well as the mass of adenomatous tissue resected (p = 0.412). Resection speed was comparable (OP-0.9 vs ThuFLEP-1.0 g/min, p = 0.52). Patients in OP had significantly longer catheterization time and length of hospital stay (9.0 days vs 3.3 days, p < 0.001). At 6 months, stress urinary incontinence rate were 1.1% after ThuFLEP and 2.5% after OP.
Despite the equally high efficacy of both modalities for infravesical obstruction due to BPH, ThuFLEP is a minimally invasive modality that is associated with a shorter hospital stay, a significantly greater return to normal activities, and a considerable reduction in rehabilitation time. Our results demonstrated that the ThuFLEP is a highly efficacious, minimally invasive modality for the management of BPH in large volume glands (>80 cc).
本研究旨在评估新型钬光纤激光前列腺剜除术（ThuFLEP）与传统开放耻骨后前列腺切除术（OP）治疗大体积良性前列腺增生（BPH）的疗效和安全性。
我们回顾性分析了 2015 年至 2017 年间接受手术治疗的大体积 BPH（>80cc）患者。术前患者检查包括功能参数评估：国际前列腺症状评分（IPSS）、生活质量（QoL）、最大尿流率（Q）和残余尿量。术前和术后均测量血红蛋白水平。
共有 130 例患者纳入研究。其中，40 例行 OP，90 例行 ThuFLEP。两组患者术前功能参数（IPSS、QoL 和 Q）相似。两种手术的平均手术时间相当（p=0.285），切除的腺瘤组织质量相当（p=0.412）。切除速度相当（OP-0.9 与 ThuFLEP-1.0g/min，p=0.52）。OP 组的导尿管留置时间和住院时间明显长于 ThuFLEP 组（9.0 天与 3.3 天，p<0.001）。6 个月时，ThuFLEP 组和 OP 组的压力性尿失禁发生率分别为 1.1%和 2.5%。
尽管两种方法治疗 BPH 下尿路梗阻的效果相当，但 ThuFLEP 是一种微创方法，与较短的住院时间、显著更快的恢复正常活动和显著减少康复时间相关。我们的结果表明，对于大体积前列腺（>80cc），ThuFLEP 是一种高效、微创的治疗 BPH 的方法。
