Department of Urology, OLV Hospital Aalst, Aalst, Belgium.
Department of Urology, St. George's University Hospital, London, United Kingdom.
J Endourol. 2023 Aug;37(8):895-902. doi: 10.1089/end.2022.0851.
Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of ≥200 cc. Between 2009 and 2020 a total of 53 patients with a prostate volume of ≥200 cc were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and postvoid residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification. Patients treated with RASP had significantly larger prostate volumes compared with HoLEP (median 226 cc 204.5 cc, = 0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 mL/s +10.70 mL/s, = 0.724) and a reduction of the IPSS score (-12.50 -9, = 0.246) as well as improvement of the QoL (-3 -3, = 0.880). Median operative time was similar in both groups (150 minutes 132.5 minutes, = 0.665). The amount of resected tissue was lower in the RASP group (134.5 g 180 g, = 0.029) and there was no significant difference in postoperative prostate-specific antigen (1.2 ng/mL 0.8 ng/mL, = 0.112). Despite a similar median catheterization time (3 days 2 days, = 0.748), the median hospitalization time was shorter in the HoLEP group (4 days 3 days, = 0.052). Complication rates were similar in both groups (32% 36%, = 0.987). Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates ≥200 cc. These findings will require external validation at other high-volume centers.
机器人辅助单纯前列腺切除术（RASP）和钬激光前列腺剜除术（HoLEP）是治疗良性前列腺增生引起下尿路症状的两种成熟的微创外科治疗方法。我们已经报道了首次对前列腺体积≥200cc 的这两种技术的比较分析。 2009 年至 2020 年，在奥尔德斯塔特 OLV 医院（比利时）对 53 名前列腺体积≥200cc 的患者进行了手术治疗：31 名患者接受 RASP，22 名患者接受 HoLEP。术前和术后评估包括尿流率（最大尿流率 Qmax）和残余尿量（PVR），以及国际前列腺症状评分（IPSS）和生活质量评分（IPSS-QoL）。并发症发生率根据 Clavien-Dindo 分类进行评估。 与 HoLEP 相比，接受 RASP 治疗的患者前列腺体积明显更大（中位数 226cc 204.5cc，=0.004）。中位随访 14 个月后，两组最大尿流率均显著改善（+10.60mL/s +10.70mL/s，=0.724），IPSS 评分降低（-12.50 -9，=0.246），生活质量改善（-3 -3，=0.880）。两组的中位手术时间相似（150 分钟 132.5 分钟，=0.665）。RASP 组切除组织量较低（134.5g 180g，=0.029），术后前列腺特异性抗原（PSA）无显著差异（1.2ng/mL 0.8ng/mL，=0.112）。尽管中位导尿管留置时间相似（3 天 2 天，=0.748），但 HoLEP 组的中位住院时间较短（4 天 3 天，=0.052）。两组的并发症发生率相似（32% 36%，=0.987）。 我们的研究结果表明，对于前列腺体积≥200cc 的非常大的前列腺，RASP 和 HoLEP 的结果相似。这些发现需要在其他高容量中心进行外部验证。
