Talamini Susan, Lai Andrew, Palmer Cassandra, van de Walle Gabriel, Zuberek Marcin, Crivellaro Simone
Washington University School of Medicine St. Louis Missouri USA.
College of Medicine University of Illinois at Chicago Chicago Illinois USA.
BJUI Compass. 2023 Jun 22;4(5):549-555. doi: 10.1002/bco2.261. eCollection 2023 Sep.
The objective of this work is to compare our outcomes using thulium laser enucleation of prostate (ThuLEP) to the single-port robot-assisted simple prostatectomy (SP RASP) in the surgical management of benign prostatic hyperplasia (BPH).
A retrospective cohort study was conducted from January 2017 through December 2021 of men who underwent SP RASP and ThuLEP performed by a single surgeon with an enucleation experience of >300 cases and extensive robotic experience. The primary outcome was changed in International Prostate Symptom Score (IPSS) postoperatively. Secondary outcomes were operative time, length of stay (LOS), change in post-void residuals (PVR), de novo stress- or urge-urinary incontinence (SUI, UUI), and rate of complications.
One hundred two patients underwent surgery during the study period: 33 RASP and 69 ThuLEP. There was no difference in preoperative characteristics, including age and body mass index, between both groups. Changes in IPSS scores postoperatively were not significant between SP RASP versus ThuLEP (-17 vs. -14, = 0.2956). SP RASP had a longer operative time (180 vs. 90 min, < 0.0001). There was no difference in LOS (0 vs. 0 days, = 0.2904). There was no difference in change in PVR (-96 vs. -91 mL, = 0.8504). SP RASP patients had significantly less postoperative SUI than ThuLEP (0 vs. 13 patients, = 0.0083), while there was no difference in UUI between both groups (4 vs. 2 patients, = 0.0843). There was no difference in 30-day complication rate (21.2% vs. 21.7%, = 0.9517), although there were three ThuLEP patients with Clavien-Dindo Class III or higher complication.
There was no difference in change in IPSS scores between the two groups. ThuLEP is associated with shorter postoperative catheter days and decreased operative times. Hospital LOS was equivalent. SP RASP demonstrates significantly improved continence rates. Though SP RASP is within the initial learning curve at our institution, early results demonstrate the role for this modality alongside ThuLEP in the treatment of large gland BPH.
本研究旨在比较我们使用铥激光前列腺剜除术（ThuLEP）与单孔机器人辅助单纯前列腺切除术（SP RASP）治疗良性前列腺增生（BPH）的手术效果。
对2017年1月至2021年12月期间由一位具有超过300例剜除经验和丰富机器人手术经验的外科医生实施SP RASP和ThuLEP手术的男性患者进行回顾性队列研究。主要结局指标为术后国际前列腺症状评分（IPSS）的变化。次要结局指标包括手术时间、住院时间（LOS）、残余尿量（PVR）变化、新发压力性或急迫性尿失禁（SUI、UUI）以及并发症发生率。
在研究期间，102例患者接受了手术：33例行RASP手术，69例行ThuLEP手术。两组患者术前特征（包括年龄和体重指数）无差异。SP RASP组与ThuLEP组术后IPSS评分变化无显著差异（-17 vs. -14，P = 0.2956）。SP RASP组手术时间更长（180分钟 vs. 90分钟，P < 0.0001）。住院时间无差异（0天 vs. 0天，P = 0.2904）。PVR变化无差异（-96 mL vs. -91 mL，P = 0.8504）。SP RASP组术后SUI患者明显少于ThuLEP组（0例 vs. 13例，P = 0.0083），而两组UUI患者无差异（4例 vs. 2例，P = 0.0843）。30天并发症发生率无差异（21.2% vs. 21.7%，P = 0.9517），尽管有3例ThuLEP患者发生Clavien-Dindo III级或更高级别的并发症。
两组IPSS评分变化无差异。ThuLEP术后导尿管留置天数较短，手术时间缩短。住院时间相当。SP RASP的控尿率显著提高。尽管SP RASP在我们机构仍处于初步学习曲线阶段，但早期结果表明该术式在治疗大体积前列腺BPH方面与ThuLEP具有同等作用。
