Castellani Daniele, Enikeev Dmitry, Gokce Mehmet Ilker, Petov Vladislav, Gadzhiev Nariman, Mahajan Abhay, Maheshwari Pankaj Nandkishore, Fong Khi Yung, Tursunkulov Azimdjon N, Malkhasyan Vigen, Zawadzki Marek, Sofer Mario, Cormio Luigi, Busetto Gian Maria, Somani Bhaskar Kumar, Herrmann Thomas R W, Gauhar Vineet
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation.
Eur Urol Open Sci. 2024 Mar 21;63:38-43. doi: 10.1016/j.euros.2024.03.004. eCollection 2024 May.
The use of the new thulium fiber laser in enucleation of the prostate (ThuFLEP) has been introduced recently.
To evaluate complications and urinary incontinence (UI) after ThuFLEP in small and large prostate volume (PV).
We retrospectively reviewed patients who underwent ThuFLEP in six centers (from January 2020 to January 2023). The exclusion criteria were concomitant lower urinary tract surgery, previous prostate/urethral surgery, prostate cancer, and pelvic radiotherapy.
Patients were divided into two groups: group 1: PV ≤80 ml; group 2: PV >80 ml. Univariable and multivariable logistic regression analyses were performed to evaluate the independent predictors of overall UI.
There were 1458 patients in group 1 and 1274 in group 2. There was no significant difference in age. The median PV was 60 (61-72) ml in group 1 and 100 (90-122) ml in group 2. En bloc enucleation was employed more in group 1, while the early apical release technique was used more in group 2. The rate of prolonged irrigation for hematuria, urinary tract infection, and acute urinary retention did not differ significantly. Blood transfusion rate was significantly higher in group 2 (0.5% vs 2.0%, = 0.001). There was no significant difference in the overall UI rate (12.3% in group 1 vs 14.7% in group 2, = 0.08). A multivariable regression analysis showed that preoperative postvoiding urine residual (odds ratio 1.004, 95% confidence interval 1.002-1.007, < 0.01) was the only factor significantly associated with higher odds of UI. A limitation of this study was its retrospective nature.
Complications and UI rates following ThuFLEP were similar in patients with a PV up to or larger than 80 ml except for the blood transfusion rate that was higher in the latter.
In this study, we looked at outcomes after thulium fiber laser in enucleation of the prostate stratified by PV. We found that blood transfusion was higher in men with PV >80 ml, but urinary incontinence was similar.
新型铥光纤激光在前列腺剜除术（ThuFLEP）中的应用最近已被引入。
评估小体积和大体积前列腺（PV）患者行ThuFLEP术后的并发症及尿失禁（UI）情况。
设计、地点和参与者：我们回顾性分析了在六个中心（2020年1月至2023年1月）接受ThuFLEP手术的患者。排除标准为合并下尿路手术、既往前列腺/尿道手术、前列腺癌及盆腔放疗。
患者分为两组：第1组：PV≤80ml；第2组：PV>80ml。进行单变量和多变量逻辑回归分析以评估总体UI的独立预测因素。
第1组有1458例患者，第2组有1274例患者。年龄无显著差异。第1组的中位PV为60（61 - 72）ml，第2组为100（90 - 122）ml。第1组更多采用整块剜除术，而第2组更多采用早期尖部松解技术。血尿延长冲洗、尿路感染及急性尿潴留的发生率无显著差异。第2组的输血率显著更高（0.5%对2.0%，P = 0.001）。总体UI发生率无显著差异（第1组为12.3%，第2组为14.7%，P = 0.08）。多变量回归分析显示，术前排尿后残余尿量（比值比1.004，95%置信区间1.002 - 1.007，P < 0.01）是与UI几率较高显著相关的唯一因素。本研究的局限性在于其回顾性。
PV达80ml及以上的患者行ThuFLEP术后的并发症和UI发生率相似，但后者的输血率更高。
在本研究中，我们观察了按PV分层的铥光纤激光前列腺剜除术后的结果。我们发现PV>80ml的男性输血率更高，但尿失禁情况相似。
