Yilmaz Mehmet, Karaaslan Mustafa, Aybal Halil Cagri, Ferry von Bargen Maximilian, Tonyali Senol, Toprak Tuncay, Gratzke Christian, Miernik Arkadiusz
University of Freiburg - Medical Center, Faculty of Medicine, Department of Urology, Hugstetter Str. 55, 79106, Freiburg, Germany.
Bingol State Hospital, Department of Urology, Bingol, Turkey.
Ann Med Surg (Lond). 2022 Jul 31;80:104279. doi: 10.1016/j.amsu.2022.104279. eCollection 2022 Aug.
Surgical treatment options for lower urinary tract symptoms can differ according to prostate size. There are few studies on the efficacy and safety of endoscopic enucleation of prostate (EEP) in patients with very large prostates focusing on laser as energy source. In this systematic review, we aimed to examine the efficacy and safety of laser-based EEP on prostate glands ≥150 ml.
A systematic search was conducted using Web of Science, PubMed-MEDLINE, Wiley Online Library and Cochrane Library databases with the following search terms solely or in combination: "large prostate", "laser enucleation", "laser prostatectomy"by combining PICO (population, intervention, comparison, and outcome) terms. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed.
We retrieved 6 studies included 375 patients with prostate sizes ≥175 ml treated with laser-based EEP for symptomatic benign prostatic obstruction. Three studies examined Holmium laser enucleation of prostate (HoLEP) outcomes with a prostate volume (PV) >200 ml, one evaluated HoLEP outcomes with a PV of 200-299 and ≥ 300 ml, two studies evaluated HoLEP outcomes with a PV > 175 ml. We observed improvement in postoperative functional outcomes in patients with a PV > 175, >200 and >300 ml. The retreatment rate was 0-1.3% in all studies involving prostate size ≥175 ml. Most of the complications were Clavien-Dindo I (%0-9) and II (%12.7-16.6).
Laser-based EEP is an efficient, safe and feasible procedure even in very large prostates with good functional outcomes, low perioperative complication and retreatment rates.
下尿路症状的手术治疗方案可能因前列腺大小而异。针对以激光为能量源的前列腺内镜剜除术（EEP）在前列腺体积非常大的患者中的疗效和安全性的研究较少。在本系统评价中，我们旨在研究基于激光的EEP治疗前列腺体积≥150ml患者的疗效和安全性。
使用Web of Science、PubMed-MEDLINE、Wiley Online Library和Cochrane Library数据库进行系统检索，检索词单独或组合使用：“大前列腺”、“激光剜除术”、“激光前列腺切除术”，并结合PICO（人群、干预措施、对照和结局）术语。遵循系统评价和Meta分析的首选报告项目指南。
我们检索到6项研究，包括375例前列腺体积≥175ml的患者，接受基于激光的EEP治疗有症状的良性前列腺梗阻。3项研究考察了前列腺体积（PV）>200ml的钬激光前列腺剜除术（HoLEP）结局，1项评估了PV为200-299ml和≥300ml的HoLEP结局，2项研究评估了PV>175ml的HoLEP结局。我们观察到PV>175ml、>200ml和>300ml的患者术后功能结局有所改善。在所有涉及前列腺体积≥175ml的研究中，再次治疗率为0-1.3%。大多数并发症为Clavien-Dindo I级（0%-9%）和II级（12.7%-16.6%）。
即使对于非常大的前列腺，基于激光的EEP也是一种有效、安全且可行的手术，具有良好的功能结局、较低的围手术期并发症和再次治疗率。
