Das Akhil K, Teplitsky Seth, Humphreys Mitchell R
Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Can J Urol. 2019 Aug;26(4 Suppl 1):13-19.
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases affecting the aging man, with almost 80% of men greater than 70 affected. Historically, transurethral resection of the prostate (TURP) has been considered the historical gold standard in the treatment of LUTS due to BPH for many years, contemporary literature indicates that holmium laser enucleation of the prostate (HoLEP) has replaced TURP and open simple prostatectomy as the size independent surgical gold standard for BPH treatment.
In this review, we discuss the current techniques utilized, outcomes and safety, as well as the long term durability of results. Adverse events associated with the HoLEP procedure, both enucleation and morcellation, are covered as well.
HoLEP has a robust body of literature supporting the technique, which demonstrates its ability to surpass other surgical BPH procedures, including TURP and open simple prostatectomy. Additionally, there is long term durability of both subjective and objective outcomes greater than 10 years associated with this procedure. One randomized trial showed specific postoperative outcome measures that were superior to TURP at 7 years of follow up, including Qmax (4.36 mL/s improvement), erectile function (2.39 points improvement on the IIEF erectile function section), and weight of prostate removed (15.7 grams greater), while other studies have shown greater reduction in postoperative PSA, lower detrusor pressure at Qmax, and more.
Overall, HoLEP has proven to be an extremely durable and effective treatment for patients suffering from LUTS due to BPH. Both the Europeans and AUA guidelines on the surgical treatment of BPH recommend HoLEP as a size-independent treatment option for those men with moderate to severe symptoms. HoLEP is an excellent option for many patients who may not be good candidates for other procedures based on prostate size, age, or bleeding risk.
良性前列腺增生（BPH）继发的下尿路症状（LUTS）是影响老年男性的最常见疾病之一，70岁以上男性中近80%受其影响。从历史上看，多年来经尿道前列腺切除术（TURP）一直被视为治疗BPH所致LUTS的历史金标准，但当代文献表明，钬激光前列腺剜除术（HoLEP）已取代TURP和开放性单纯前列腺切除术，成为BPH治疗中与前列腺大小无关的手术金标准。
在本综述中，我们讨论了当前使用的技术、结果和安全性，以及结果的长期持久性。还涵盖了与HoLEP手术（包括剜除和粉碎）相关的不良事件。
HoLEP有大量文献支持该技术，表明其能够超越其他治疗BPH的手术方法，包括TURP和开放性单纯前列腺切除术。此外，该手术在主观和客观结果方面都有超过10年的长期持久性。一项随机试验显示，在7年的随访中，特定的术后结果指标优于TURP，包括最大尿流率（改善4.36 mL/s）、勃起功能（国际勃起功能指数勃起功能部分提高2.39分）以及切除的前列腺重量（多15.7克），而其他研究显示术后前列腺特异性抗原（PSA）降低更多、最大尿流率时逼尿肌压力更低等。
总体而言，对于因BPH而患有LUTS的患者，HoLEP已被证明是一种极其持久且有效的治疗方法。欧洲和美国泌尿外科学会（AUA）关于BPH手术治疗的指南均推荐HoLEP作为中度至重度症状男性与前列腺大小无关的治疗选择。对于许多基于前列腺大小、年龄或出血风险可能不适合其他手术的患者来说，HoLEP是一个极佳的选择。
