Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Investig Clin Urol. 2023 Jan;64(1):31-40. doi: 10.4111/icu.20220232.
To evaluate the effect of urinary retention (UR) on holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms.
A retrospective analysis of a prospective cohort of patients who underwent HoLEP between January 2010 and December 2016 was performed. The perioperative factors, including the International Prostate Symptom Score, Overactive Bladder Symptom Score, prostate-specific antigen, urodynamic study results, uroflowmetry results, transrectal ultrasound prostate volume, operative time, morcellation time, enucleation weight, and complications, were evaluated. Postoperative evaluation was performed at 2, 3, and 6 months.
Overall, 903 patients were identified. The mean age and follow-up were 68.3 years and 6 months, respectively. Among the patients, 135 (15.0%) patients had a history of acute UR (AUR), and 36 patients (4.0%) had chronic UR (CUR). The mean detrusor pressures at maximum flow were 64.4, 74.3, and 77.7 cmHO (p<0.001). The mean maximum flow rates (Qmax) were 7.6, 6.6, and 4.8 mL/s (p<0.001). Additionally, the mean bladder outlet obstruction indices were 49.5, 61.1, and 69.4 (p<0.001). The postoperative Qmax improved in all three groups. The mean postvoid residual volumes (PVRs) were 55, 75, and 333 mL preoperatively; 20, 29, and 66 mL at 2 weeks; 16, 23, and 45 mL at 3 months; and 15, 22, and 52 mL at 6 months (p<0.001).
Voiding symptoms, PVR, and Qmax of BPH patients with preoperative AUR and CUR significantly improved after Ho-LEP, similar to those without preoperative UR.
评估尿潴留（UR）对良性前列腺增生（BPH）和下尿路症状患者行钬激光前列腺剜除术（HoLEP）的影响。
对 2010 年 1 月至 2016 年 12 月期间行 HoLEP 的患者前瞻性队列进行回顾性分析。评估围手术期因素，包括国际前列腺症状评分、膀胱过度活动症症状评分、前列腺特异性抗原、尿动力学研究结果、尿流率结果、经直肠超声前列腺体积、手术时间、粉碎时间、剜除重量和并发症。术后 2、3 和 6 个月进行评估。
共纳入 903 例患者，平均年龄为 68.3 岁，随访时间为 6 个月。其中 135 例（15.0%）患者有急性 UR（AUR）病史，36 例（4.0%）患者有慢性 UR（CUR）病史。最大尿流率时逼尿肌压力分别为 64.4、74.3 和 77.7cmH2O（p<0.001）。最大尿流率分别为 7.6、6.6 和 4.8mL/s（p<0.001）。此外，膀胱出口梗阻指数分别为 49.5、61.1 和 69.4（p<0.001）。三组患者术后最大尿流率均有改善。术前患者的剩余尿量（PVR）分别为 55、75 和 333mL；术后 2 周分别为 20、29 和 66mL；术后 3 个月分别为 16、23 和 45mL；术后 6 个月分别为 15、22 和 52mL（p<0.001）。
与术前无 UR 患者相比，HoLEP 术后 AUR 和 CUR 的 BPH 患者的排尿症状、PVR 和最大尿流率均有显著改善。
