Herrmann Thomas R W, Gravas Stavros, de la Rosette Jean Jmch, Wolters Mathias, Anastasiadis Aristotelis G, Giannakis Ioannis
Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland.
Department of Urology, Hannover Medical School, 30625 Hannover, Germany.
J Clin Med. 2020 May 10;9(5):1412. doi: 10.3390/jcm9051412.
The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
首字母缩写词EEP代表经尿道前列腺内镜剜除术，由欧洲泌尿外科学会（EAU）非神经源性男性下尿路症状（LUTS）和良性前列腺梗阻（BPO）管理指南小组于2016年提出。从那时起，基于激光的治疗方法——钬激光前列腺剜除术（HoLEP）和基于电流的前列腺双极剜除术（BipoLEP），作为良性前列腺梗阻（BPO）管理的有价值选择同样受到认可。这主要受到两项关于随机对照试验的荟萃分析结果的启发，这些分析比较了开放性前列腺切除术与钬激光前列腺剜除术（HoLEP）或前列腺双极剜除术（BipoLEP）。在此之前，HoLEP被视为经尿道剜除术的唯一有效选择，尽管早在2006年就有等效性的证据，但由于基于双极能量治疗的大量首字母缩写词以及盛行的以HoLEP为中心的观念，该证据未得到认可。另一方面，学术讨论聚焦于出现的不同（其他）激光方法，以2009年的铥：钇铝石榴石（Tm:YAG）汽化剜除术（ThuVEP）为先导，最终在2010年出现了在Tm:YAG支持下的经尿道解剖性剜除术（铥激光前列腺剜除术，ThuLEP）。最初，关于激光的讨论分别聚焦于激光的不同特性而非技术或手术解剖结构。在2016年及之后，讨论最终转向手术技术，并将解剖学准备视为所有EEP技术（AEEP）的共性。从那时起，鉴于这些设备的总体拥有成本（TCO），根据现有证据提出了一个未言明的问题，即进行EEP是否仍然需要激光。本文权衡了当前证据，得出结论：就任何终点而言，没有证据表明一种方式优于另一种方式。因此，至关重要的是，在不使用激光技术且不影响效果的情况下，可以安全有效地进行AEEP。
