Ahyai Sascha A, Marik Irina, Ludwig Tim A, Becker Andreas, Asdjodi Saman, Kluth Luis, Chun Felix, Fisch Margit, Schmid Marianne
Department of Urology, University Medical Center Goettingen, Robert-Koch-St. 40, 37075, Goettingen, Germany.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
World J Urol. 2020 Dec;38(12):3207-3217. doi: 10.1007/s00345-020-03126-x. Epub 2020 Feb 21.
To prospectively investigate early and consecutive changes of lower urinary tract symptoms (LUTS), specifically storage symptoms after holmium laser enucleation of the prostate (HoLEP).
Patients referred for HoLEP completed the International Prostatic Symptom Score (IPSS) the day before, at discharge, and 1, 2, 3, 4, 6, 8, 12, 16, 20, 24, and 52 weeks after HoLEP. Total IPSS was stratified into mild (score 0-7), moderate (8-19), and severe (20-35) LUTS. Storage symptoms were sub-stratified into storage "negative" and "positive". IPSS changes served as the main postoperative outcome. Mixed linear models identified risk factors affecting postoperative recovery of LUTS.
Between December 2010 and 2012, 144 consecutive HoLEP patients were prospectively included in the study. Preoperatively 57.6% of the cohort reported severe storage symptoms (mean total IPSS: 22.6 ± 5.0). Total IPSS decreased significantly immediately after surgery (p < 0.001). Patients with severe LUTS, storage-positive sub-score, and high maximum urinary flow rate were affected by a rebound of mainly storage symptoms 6-8 weeks after HoLEP and prolonged recovery from LUTS. Of these, about 7.4% presented persisting urge complaints. Finally, 12 weeks following HoLEP, the vast majority of patients were symptom-free. Limitations of this study include missing urodynamic workup and a comparative patient cohort.
Immediately after HoLEP, patients experience a significant decrease of LUTS. Continuous symptom recovery seems to be hampered in patients with severe and storage-positive baseline symptoms. (De-novo) storage symptoms slightly affect postoperative recovery. Quality of life is restored to a stable and significantly improved status 3 months after surgery.
前瞻性研究前列腺钬激光剜除术（HoLEP）后下尿路症状（LUTS）的早期及连续变化，特别是储尿期症状。
接受HoLEP治疗的患者在术前一天、出院时以及HoLEP术后1、2、3、4、6、8、12、16、20、24和52周完成国际前列腺症状评分（IPSS）。总IPSS分为轻度（评分0 - 7）、中度（8 - 19）和重度（20 - 35）LUTS。储尿期症状再细分为储尿期“阴性”和“阳性”。IPSS变化作为主要的术后结局。混合线性模型确定影响LUTS术后恢复的危险因素。
2010年12月至2012年期间，144例连续接受HoLEP治疗的患者被前瞻性纳入研究。术前，57.6%的队列报告有严重储尿期症状（平均总IPSS：22.6±5.0）。术后总IPSS立即显著下降（p < 0.001）。重度LUTS、储尿期阳性亚评分和最大尿流率高的患者在HoLEP术后6 - 8周主要受储尿期症状反弹影响，LUTS恢复时间延长。其中，约7.4%出现持续的尿急症状。最后，HoLEP术后12周，绝大多数患者无症状。本研究的局限性包括缺少尿动力学检查和对照患者队列。
HoLEP术后，患者的LUTS立即显著下降。基线症状严重且储尿期阳性的患者，症状的持续恢复似乎受到阻碍。（新发）储尿期症状对术后恢复有轻微影响。术后3个月生活质量恢复到稳定且显著改善的状态。
