Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Rubensstraße 125, 12157, Berlin, Germany.
Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
World J Urol. 2021 Jul;39(7):2337-2345. doi: 10.1007/s00345-021-03598-5. Epub 2021 Jan 24.
Holmium Laser Enucleation of the Prostate (HoLEP) is widely accepted as standard laser enucleation technique for patients with benign prostate obstruction (BPO). Initially developed as a three-lobe enucleation technique, several modifications have been published. Comparison of the enucleation techniques is lacking. Therefor we aimed to compare outcomes of three enucleation techniques (en-bloc vs. two-lobe vs. three-lobe).
We prospectively collected data of 600 patients treated between 01/2017 and 12/2017 with HoLEP for BPO. Patients were randomised to either enbloc, two-lobe, or three-lobe enucleation, respectively. Data collection consisted of parameters on operation time, perioperative parameters, and functional outcomes. Univariate and multivariate analyses (ANOVA-test for continuous variables; Chi2-test for categorical variables) were performed regarding differences between the three enucleation techniques.
Patient characteristics were not significantly different (all p > 0.05). Significant differences were observed with respect to overall operation time (en-bloc vs. two-lobe vs. three-lobe: 40.5 vs. 40.7 vs. 47.9, respectively; p < 0.001), speed (g/min.) (en-bloc vs. two-lobe vs. three-lobe, 1.82 vs. 1.76 vs. 1.67, respectively; p 0.006), and enucleation time (en-bloc vs. two-lobe vs. three-lobe: 31.7 vs. 32 vs. 37.7, respectively; p < 0.001). When solely comparing en-bloc vs. two-lobe enucleation, differences in terms of enucleation time, operation time, and speed were not significantly different (p 0.8, 0.9, and 0.2, respectively). Postoperative outcomes were not significantly different.
All three HoLEP enucleation techniques show similar postoperative outcomes. However, enbloc and two-lobe enucleation are significantly faster with respect to enucleation, overall operation time, and speed compared to the three-lobe technique.
钬激光前列腺剜除术（HoLEP）已被广泛接受为治疗良性前列腺梗阻（BPO）的标准激光剜除技术。最初作为一种三叶剜除技术开发，已经发表了几种改良方法。缺乏对剜除技术的比较。因此，我们旨在比较三种剜除技术（整块 vs. 两叶 vs. 三叶）的结果。
我们前瞻性地收集了 2017 年 1 月至 12 月期间接受 HoLEP 治疗 BPO 的 600 例患者的数据。患者被随机分为整块、两叶或三叶剜除组。数据收集包括手术时间、围手术期参数和功能结果参数。使用单变量和多变量分析（连续变量的 ANOVA 检验；分类变量的 Chi2 检验）比较三种剜除技术之间的差异。
患者特征无显著差异（均 p > 0.05）。在整体手术时间（整块 vs. 两叶 vs. 三叶：分别为 40.5、40.7 和 47.9；p < 0.001）、速度（g/min.）（整块 vs. 两叶 vs. 三叶，分别为 1.82、1.76 和 1.67；p < 0.006）和剜除时间（整块 vs. 两叶 vs. 三叶：分别为 31.7、32 和 37.7；p < 0.001）方面观察到显著差异。当仅比较整块与两叶剜除时，剜除时间、手术时间和速度方面的差异无统计学意义（p 分别为 0.8、0.9 和 0.2）。术后结果无显著差异。
三种 HoLEP 剜除技术的术后结果相似。然而，整块和两叶剜除在剜除、整体手术时间和速度方面明显快于三叶技术。
