Kim Dae Hyun, Kang Chang Suk, Choi Jae Whi, Jeh Seong Uk, Choi See Min, Lee Chun Woo, Kam Sung Chul, Hwa Jeong Seok, Hyun Jae Seog
Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea.
Department of Urology, Gyeongsang National University Changwon Hospital, Changwon, Korea.
World J Mens Health. 2023 Oct;41(4):951-959. doi: 10.5534/wjmh.220225. Epub 2023 Apr 3.
To evaluate the safety, efficiency, and size-dependency of the 'Inverted omega (Ʊ)' holmium laser enucleation of the prostate (HoLEP) in benign prostate hyperplasia (BPH) with lower urinary tract symptoms.
A retrospective analysis of 716 consecutive patients who underwent HoLEP under the care of a single surgeon from 2014-2021. These patients were treated using the 'Inverted omega ' HoLEP technique for BPH. The patients were divided into 3 groups: Group 1 (<40 mL, n=328), Group 2 (40-60 mL, n=221), and Group 3 (≤60 mL, n=167). Perioperative parameters, safety, and functional outcomes were assessed and analyzed.
The perioperative parameters, like enucleation time (45.8±26.9 min), morcellation time (13.2±47.5 min), and catheterization duration (1.6±1.2 d) significantly differed to favor smaller prostate sizes (p<0.01). Significant improvements in the IPSS (total, voiding, storage, and quality of life), post-void residual urine, and maximum flow rate were observed 3 months post-HoLEP and continued during the 1-year follow-up period in all groups (p<0.01). The postoperative complications included urethral stricture in 11 patients (1.5%), bladder neck contracture in 12 (1.7%), urinary incontinence in 14 (2.0%), and bladder injuries in 4 (0.6%). Bladder neck contractures occurred only in Group 1. The postoperative surgical management for complications included urethral sounding (n=9, 1.3%), endoscopic internal urethrotomy (n=2, 0.3%), and re-HoLEP for bladder neck contractures in (n=12, 1.7%). The rate of re-HoLEP for regrowing adenomas was 15 (2.1%). Postoperative medications exceeding 6 months were α-blocker (n=22, 3.1%), cholinergics (n=16, 2.2%), anticholinergics (n=58, 8.1%), antidiuretics (n=18, 2.5%), and daily PDE5 inhibitor (n=38, 5.3%). Thirty-four patients (4.7%) had postoperative incidental prostate cancer.
The inverted omega HoLEP technique is safe and effective for the treatment of BPH. Moreover, 'Inverted omega ' HoLEP is a size-independent and effective method for all prostate sizes.
评估“倒Ω（Ʊ）”钬激光前列腺剜除术（HoLEP）治疗良性前列腺增生（BPH）伴下尿路症状的安全性、有效性及前列腺大小依赖性。
回顾性分析2014年至2021年在一名外科医生治疗下连续接受HoLEP手术的716例患者。这些患者采用“倒Ω”HoLEP技术治疗BPH。患者分为3组：第1组（<40 mL，n = 328）、第2组（40 - 60 mL，n = 221）和第3组（≤60 mL，n = 167）。评估并分析围手术期参数、安全性和功能结局。
围手术期参数，如剜除时间（45.8±26.9分钟）、粉碎时间（13.2±47.5分钟）和导尿持续时间（1.6±1.2天）在前列腺体积较小时有显著差异（p<0.01）。所有组在HoLEP术后3个月时国际前列腺症状评分（IPSS，包括总分、排尿、储尿和生活质量）、残余尿量和最大尿流率均有显著改善，并在1年随访期内持续改善（p<0.01）。术后并发症包括11例（1.5%）尿道狭窄、12例（1.7%）膀胱颈挛缩、14例（2.0%）尿失禁和4例（0.6%）膀胱损伤。膀胱颈挛缩仅发生在第1组。并发症的术后手术处理包括尿道扩张（n = 9，1.3%）、内镜下尿道内切开术（n = 2，0.3%）以及针对膀胱颈挛缩的再次HoLEP手术（n = 12，1.7%）。腺瘤复发再次行HoLEP手术的比例为15例（2.1%）超过6个月的术后用药包括α受体阻滞剂（n = 22，3.1%）、胆碱能药物（n = 16，2.2%）、抗胆碱能药物（n = 58，8.1%）、抗利尿药（n = 18，2.5%）和每日使用的磷酸二酯酶5抑制剂（n = 38，5.3%）。34例患者（4.7%）术后发现偶发前列腺癌。
“倒Ω”HoLEP技术治疗BPH安全有效。此外，“倒Ω”HoLEP对所有前列腺大小都是一种与大小无关的有效方法。
