Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy.
Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
Eur Urol Focus. 2023 Sep;9(5):813-821. doi: 10.1016/j.euf.2023.03.018. Epub 2023 Apr 15.
Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure even for surgeons who have completed the learning curve.
To assess outcomes and complications following HoLEP performed by a highly experienced surgeon.
DESIGN, SETTING, AND PARTICIPANTS: This was a single-institution prospective study (NCT03583034) performed at a tertiary referral centre that included 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single experienced surgeon (>1600 cases).
Patients were assessed using validated questionnaires and uroflowmetry at baseline and several follow-up dates. Intraoperative and postoperative complications were recorded. Kaplan-Meier analysis was used to estimate recovery rates for urinary continence and erectile function. Logistic regression models were constructed to assess predictors of postoperative complications.
Of the 243 patients, 78 (32.1%) had an indwelling urethral catheter. The median prostate volume (PV) was 87 cm (interquartile range 60-115) and 146 patients (59.8%) had PV >80 cm. At 3-mo follow-up, 219 patients (90.1%) had a peak flow rate >20 ml/s and 182 (74.9%) had no postvoid residual urine. The improvement in subjective symptoms was significant at 1-mo follow-up and was maintained until 12 mo after surgery. Urinary continence recovery was slow, with an estimated rate of 68% (95% confidence interval [CI] 62-74%) at 1 mo and 94% (95% CI 91-97%) at 12 mo after HoLEP. The recovery rate for erectile function was 53% (95% CI 46-61%) at 1 mo and 85% (95% CI 77-90%) at 12 mo. Postoperative complications occurred in 36 patients (14.8%) during their hospital stay, in 34 (14%) within 1 mo following discharge from hospital, and in ten (4.1%) at later follow-up dates. Clinically significant complications (Clavien-Dindo ≥2) were observed in 44 cases (18%) and were more common for patients with an indwelling catheter at baseline (odds ratio 5.05; p = 0.006).
HoLEP is an effective procedure for treating LUTS due to BPE, although it is not devoid of complications and sequelae, even in the hands of a highly experienced surgeon.
Holmium laser treatment of the prostate to reduce its size has positive results for urinary function when performed by an experienced surgeon, even in complex cases, although there can be complications.
即使对于已经完成学习曲线的外科医生来说，钬激光前列腺剜除术（HoLEP）也被认为是一项具有挑战性的手术。
评估由经验丰富的外科医生进行 HoLEP 后的结果和并发症。
设计、地点和参与者：这是一项单中心前瞻性研究（NCT03583034），在一家三级转诊中心进行，纳入了 243 例因良性前列腺增生（BPE）而下尿路症状（LUTS）的连续患者，这些患者由一位经验丰富的外科医生（>1600 例）行 HoLEP 治疗。
患者在基线和多个随访日期使用经过验证的问卷和尿流率进行评估。记录术中及术后并发症。采用 Kaplan-Meier 分析估计尿控和勃起功能恢复率。构建逻辑回归模型评估术后并发症的预测因素。
243 例患者中，78 例（32.1%）留置导尿管。前列腺体积中位数（PV）为 87 cm（四分位间距 60-115），146 例（59.8%）PV>80 cm。在 3 个月的随访时，219 例（90.1%）最大尿流率>20 ml/s，182 例（74.9%）无残余尿。术后 1 个月时主观症状明显改善，并持续至术后 12 个月。尿控恢复缓慢，HoLEP 术后 1 个月时估计恢复率为 68%（95%CI 62-74%），12 个月时为 94%（95%CI 91-97%）。勃起功能恢复率为 1 个月时 53%（95%CI 46-61%），12 个月时 85%（95%CI 77-90%）。36 例（14.8%）患者在住院期间发生术后并发症，34 例（14%）在出院后 1 个月内发生术后并发症，10 例（4.1%）在后期随访时发生术后并发症。观察到 44 例（18%）临床显著并发症（Clavien-Dindo ≥2），基线留置导尿管的患者更常见（比值比 5.05；p=0.006）。
HoLEP 是治疗 BPE 引起的 LUTS 的有效方法，但即使由经验丰富的外科医生进行，也并非没有并发症和后遗症。
由经验丰富的外科医生使用钬激光治疗前列腺以缩小其体积，对改善尿功能有积极效果，即使是在复杂的情况下，尽管可能存在并发症。
