Department of Urology, Tokyo Medical University Hospital, Tokyo, Japan.
Department of Urology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
Urol J. 2024 Mar 24;21(2):133-139. doi: 10.22037/uj.v20i.7746.
Few studies have evaluated the usefulness of anteroposterior dissection holmium laser enucleation of the prostate (HoLEP). Thus, this study investigated the incidence of stress urinary incontinence (SUI) after HoLEP and usefulness of anteroposterior dissection HoLEP in preventing postoperative SUI.
In total, 288 patients who underwent HoLEP performed by a single experienced surgeon between May 2014 and September 2021 were enrolled. Furthermore, 134 patients underwent retrograde dissection using the modified Gilling method (surgery 1) and 154 patients underwent anteroposterior dissection HoLEP (surgery 2). The risk factors for SUI, as well as the rates of SUI improvement for the two surgical procedures, were evaluated.
Postoperative SUI was observed in 58 (20.1%) of 288 patients, of whom, 48 (82.8%) recovered continence within 6 months. Ten patients (17.2%) required more than 6 months to recover continence. SUI incidence 1 month after HoLEP was 29.9% (40/134 patients) for surgery 1 and 11.7% (18/154 patients) for surgery 2; a statistically significant difference was observed between the two groups (odds ratio [OR], 0.311; 95% confidence interval [CI], 0.168-0.575; p < 0.001). In addition, surgery 2 was significantly associated with early recovery from SUI compared with surgery 1 (stratified hazard ratio, 0.782; 95% CI, 0.615------0.995; p < 0.001). The multivariable analysis demonstrated that only surgical procedure (OR, 0.350; 95%CI, 0.168-0.732; p=0.005) was an independent predictor of SUI.- Conclusion: We reaffirmed that anteroposterior dissection HoLEP is a useful procedure for reducing the risk of postoperative SUI and early recovery of urinary continence.
很少有研究评估经尿道前列腺钬激光剜除术（HoLEP）前后方解剖的有效性。因此，本研究调查了 HoLEP 后压力性尿失禁（SUI）的发生率和前后方解剖 HoLEP 在预防术后 SUI 中的作用。
2014 年 5 月至 2021 年 9 月，共纳入 288 例由同一位经验丰富的外科医生行 HoLEP 的患者。其中 134 例采用改良 Gilling 法行逆行解剖（手术 1），154 例行前后方解剖 HoLEP（手术 2）。评估了 SUI 的危险因素以及两种手术方式改善 SUI 的发生率。
288 例患者中术后 SUI 58 例（20.1%），其中 48 例（82.8%）在 6 个月内恢复控尿。10 例（17.2%）需要超过 6 个月才能恢复控尿。HoLEP 后 1 个月，手术 1 的 SUI 发生率为 29.9%（40/134 例），手术 2 的 SUI 发生率为 11.7%（18/154 例）；两组间差异有统计学意义（比值比[OR]，0.311；95%置信区间[CI]，0.168-0.575；p<0.001）。此外，与手术 1 相比，手术 2 与 SUI 的早期恢复显著相关（分层风险比，0.782；95%CI，0.615-0.995；p<0.001）。多变量分析表明，只有手术方式（OR，0.350；95%CI，0.168-0.732；p=0.005）是 SUI 的独立预测因素。
我们再次证实，前后方解剖 HoLEP 是降低术后 SUI 风险和早期恢复尿控的有效方法。
