Porreca Angelo, Schiavina Riccardo, Romagnoli Daniele, Corsi Paolo, Salvaggio Antonio, D'Agostino Daniele, Ferro Matteo, Busetto Gian Maria, Falabella Roberto, Crestani Alessandro
Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
Department of Urology, Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy.
Cent European J Urol. 2021;74(3):366-371. doi: 10.5173/ceju.2021.3.105. Epub 2021 Jul 14.
The aim of this article was to describe, step-by-step, an original technique (T-L technique) in a single centre series of patients who underwent holmium laser enucleation of the prostate (HoLEP) for symptomatic benign prostatic hyperplasia and analyze perioperative outcomes.
We retrospectively analyzed data of 567 patients who underwent HoLEP. The T-L technique consists of a series of incisions used as landmarks, performed at the beginning of the procedure before enucleation. Two T-shape incisions are performed at the level of bladder neck (at the 5-7 and 12 o'clock positions); two L-shape incisions are performed at the level of verumontanum, bilaterally, to mark the apex and to limit the sphincter. Another T-shape incision is performed on the bladder neck at the 12 o'clock position posterior to the level of verumontanum.
The median operative time (OT) was 80 minutes (IQR 64-105); 50 minutes (IQR 35-70) and 15 minutes (IQR 10-20) for enucleation and the morcellation phase, respectively. Conversion to transurethral resection of the prostate (TURP) was necessary in 3/567 (0.6%) patients. Intraoperative complications occurred in 3.4% of cases, capsule perforation occurred in 12/567 (2%) of cases, while bladder perforation during morcellation occurred in 8/567 (1.4%) of cases. Postoperative complications were observed in 20/567 (3.5%) of patients. Specifically, grade 1-2 occurred in 19/567 (3.3%) and grade 3 was recorded in 1/567 (0.2%).
The T-L technique for HoLEP is safe and reproducible with a low rate of perioperative complications. The positioning of some landmarks before enucleation allows for the better orientation during enucleation and could be very useful in case of large prostates.
本文旨在逐步描述一种原创技术（T-L技术），该技术应用于单中心一系列因症状性良性前列腺增生接受钬激光前列腺剜除术（HoLEP）的患者，并分析围手术期结果。
我们回顾性分析了567例行HoLEP患者的数据。T-L技术包括在剜除术前手术开始时作为标志进行的一系列切口。在膀胱颈水平（5-7点和12点位置）进行两个T形切口；在精阜水平双侧进行两个L形切口，以标记前列腺尖部并限制括约肌。在精阜水平后方的膀胱颈12点位置再进行一个T形切口。
中位手术时间（OT）为80分钟（四分位间距64-105）；剜除期和粉碎期分别为50分钟（四分位间距35-70）和15分钟（四分位间距10-20）。567例患者中有3例（0.6%）需要转为经尿道前列腺切除术（TURP）。术中并发症发生率为3.4%，包膜穿孔发生率为567例中的12例（2%），而粉碎期膀胱穿孔发生率为567例中的8例（1.4%）。20/567（3.5%）的患者出现术后并发症。具体而言，1-2级并发症发生在19/567（3.3%），3级并发症记录在1/567（0.2%）。
HoLEP的T-L技术安全且可重复，围手术期并发症发生率低。在剜除术前定位一些标志可使剜除过程中定位更准确，对于大体积前列腺可能非常有用。
