Kanne Martin, Beutel Holger, Krediet Jorien, Kössler Robert, Kittner Beatrice, Schmuck Nils, Spreu Thomas, Friedersdorff Frank, Maxeiner Andreas
Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Aktuelle Urol. 2023 Feb;54(1):24-29. doi: 10.1055/a-1921-9485. Epub 2022 Sep 12.
Holmium Laser Enucleation of the Prostate (HoLEP) was established 20 years ago as an alternative to Transurethral Resection of the Prostate (TUR-P) based on improved morbidity in patients with benign prostate syndrome (BPS). HoLEP can be applied independently to almost all sizes of prostate glands and is recommended in national and international guidelines. Although the HoLEP procedure has a good reputation, many patients still prefer conservative treatment due to fears of side-effects such as pain and urinary incontinence. The aim of this study was to identify patients' feelings, fears and perception of their HoLEP treatment based on Patient-reported Outcome Measures (PROMs) via questionnaires.
During the time period from June to December 2020, 152 consecutive patients were treated by HoLEP due to BPS and were interviewed based on questionnaires right after their surgical treatment and 3 months later concerning their satisfaction as well as micturition and continence. Based on a written informed consent, 112 patients were included in the study, and a complete 3-month follow-up was available for 88 patients.
The mean volume of enucleated prostate tissue was 62.1 [g] and the mean prostate volume estimated pre-operatively (trans-rectal ultrasound) was 83.1 [cm3]. Overall patient-reported satisfaction with the hospital stay including surgical treatment was 94.6%; after 3 months it was 91.8%. Concerning micturition, 76.5% of the patients reported satisfaction after surgery and 80.4% were satisfied after 3 months. Urinary incontinence was reported in 8.3% initially and in 9.1% after 3 months. Positive answers to questions concerning the quality of life index [L] were obtained in 62.1% initially and their number increased to 85.7% after 3 months. The share of negative answers decreased from 11.7% after surgery to 3.4% within the 3-month follow-up.
HoLEP is a well-established treatment of BPS with lower side-effects compared with TUR-P according to the literature. To address doubts and misgivings, it is important to perform surveys on subjective patient satisfaction after the surgical procedure and over time. The high patient satisfaction could help future patients and the urologists treating them to establish the indication for HoLEP treatment earlier in order to avoid severe LUTS or catheterization.
20年前，基于改善良性前列腺综合征（BPS）患者的发病率，钬激光前列腺剜除术（HoLEP）作为经尿道前列腺切除术（TUR-P）的替代方法被确立。HoLEP几乎可独立应用于各种大小的前列腺腺体，并且在国内和国际指南中均被推荐。尽管HoLEP手术声誉良好，但由于担心疼痛和尿失禁等副作用，许多患者仍倾向于保守治疗。本研究的目的是通过问卷调查，基于患者报告的结局指标（PROMs）来确定患者对HoLEP治疗的感受、恐惧和认知。
在2020年6月至12月期间，152例因BPS接受HoLEP治疗的连续患者在手术治疗后立即接受问卷调查，并在3个月后询问他们的满意度以及排尿和控尿情况。基于书面知情同意书，112例患者被纳入研究，88例患者获得了完整的3个月随访。
切除的前列腺组织平均体积为62.1[克]，术前（经直肠超声）估计的前列腺平均体积为83.1[立方厘米]。患者对包括手术治疗在内的住院期间的总体满意度为94.6%；3个月后为91.8%。关于排尿，76.5%的患者术后报告满意，3个月后80.4%的患者满意。最初报告有尿失禁的患者为8.3%，3个月后为9.1%。关于生活质量指数[L]问题的肯定回答最初为62.1%，3个月后增加到85.7%。否定回答的比例从术后的11.7%在3个月的随访中降至3.4%。
根据文献，HoLEP是一种成熟的BPS治疗方法，与TUR-P相比副作用更低。为了解决疑虑，在手术后及一段时间内对患者主观满意度进行调查很重要。高患者满意度有助于未来的患者以及治疗他们的泌尿科医生更早地确定HoLEP治疗的适应症，以避免严重的下尿路症状或导尿。
