Urology Department, Grupo de Investigación Salud Integral del Varón imas12, Hospital Universitario 12 Octubre, Madrid, Spain.
Hospital Universitario HM Montepríncipe, Madrid, Spain.
BJU Int. 2020 Jul;126(1):177-182. doi: 10.1111/bju.15028. Epub 2020 Feb 27.
To assess the perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in real-life practice and investigate the factors influencing the safety and effectiveness of the technique.
Critical analysis of patients with benign prostate hyperplasia (BPH) treated with HoLEP over 10 years of routine practice in three hospitals. Analysed variables included: preoperative characteristics (prostate size, active antiplatelet/anticoagulant therapy, blood parameters. prostate-specific antigen (PSA) level, maximum urinary flow rate [Q ], and International Prostate Symptom Score [IPSS]), intraoperative variables (operation time, concomitant removal of bladder calculi, and complications), early postoperative outcomes (change in blood parameters, catheterisation time, and hospital stay), and 12-month follow-up outcomes (change in IPSS, PSA level, and Q ).
The analysis included 963 patients, aged 48-91 years, with a mean (range) prostate size of 91 (35-247) mL. The mean (sd) operation time was 77 (29) min, and the hospital stay and catheterisation time were 4 (2) and 1.3 (2) days, respectively. In all, 56 patients (5.6%) required concomitant removal of bladder calculi and 36 (3.7%) were converted to open prostatectomy or transurethral resection of the prostate due to intraoperative complications. Patients had a significant decrease in haemoglobin and haematocrit, but no differences were seen between patients with and without anticoagulant/antiplatelet therapy and those with prostates ≥ and <100 mL. The concomitant removal of bladder calculi and having a prostate ≥100 mL resulted in a longer operation time, but did not influence the safety and effectiveness outcomes.
HoLEP is suitable for real-life patients with BPH, irrespective of the presence of active treatment with anticoagulant/antiplatelet, bladder lithiasis or a prostate ≥100 mL.
评估钬激光前列腺剜除术（HoLEP）在真实实践中的围手术期结果，并探讨影响该技术安全性和有效性的因素。
对三家医院 10 多年常规实践中接受 HoLEP 治疗的良性前列腺增生（BPH）患者进行关键分析。分析的变量包括：术前特征（前列腺大小、正在进行的抗血小板/抗凝治疗、血液参数、前列腺特异性抗原（PSA）水平、最大尿流率[Q]和国际前列腺症状评分[IPSS]）、术中变量（手术时间、同期膀胱结石清除和并发症）、早期术后结果（血液参数变化、导尿管留置时间和住院时间）以及 12 个月随访结果（IPSS、PSA 水平和 Q 的变化）。
该分析包括 963 名年龄在 48-91 岁的患者，前列腺平均（范围）大小为 91（35-247）ml。平均（标准差）手术时间为 77（29）分钟，住院时间和导尿管留置时间分别为 4（2）天和 1.3（2）天。共有 56 名患者（5.6%）需要同期清除膀胱结石，36 名患者（3.7%）因术中并发症转为开放性前列腺切除术或经尿道前列腺切除术。患者的血红蛋白和血细胞比容均显著下降，但正在接受抗凝/抗血小板治疗的患者与未接受抗凝/抗血小板治疗的患者以及前列腺大小≥100ml 和<100ml 的患者之间无差异。同期清除膀胱结石和前列腺大小≥100ml 会导致手术时间延长，但不会影响安全性和有效性结果。
HoLEP 适合真实生活中的 BPH 患者，无论是否存在抗凝/抗血小板治疗、膀胱结石或前列腺大小≥100ml。
