Department of Urology, Faculty of Medicine, Medical Centre - University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
World J Urol. 2024 May 9;42(1):306. doi: 10.1007/s00345-024-04997-0.
The question of best surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) remains controversial. We compared the outcomes of aquablation and holmium laser enucleation of the prostate ("HoLEP") in a prospective cohort.
Patients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume ("PV"), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo ("CD") classification.
We included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients' larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation's results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01).
While aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.
良性前列腺增生（BPH）导致下尿路症状（LUTS）的最佳手术治疗方法仍存在争议。我们在一项前瞻性队列研究中比较了经尿道水刀前列腺切除术（Aquaablation）和钬激光前列腺剜除术（HoLEP）的结果。
2020 年 6 月至 2022 年 4 月期间，根据患者偏好，将患有 BPH 的患者分为 Aquaablation 组或 HoLEP 组。术前及术后 3、6、12 个月分别评估前列腺体积（PV）、实验室结果、残余尿量、尿流率、国际前列腺症状评分（IPSS）、国际下尿路症状问卷简表（ICIQ-SF）、男性下尿路症状生活质量量表（MSHQ-EjD）、勃起功能国际指数（EES）和国际勃起功能指数（IIEF）。还通过 Clavien-Dindo（CD）分类分析围手术期特征和并发症。
共纳入 40 例患者，其中 16 例行 Aquaablation，24 例行 HoLEP。平均年龄为 67 岁（标准差 7.4）。两组基线特征平衡，除 HoLEP 患者的前列腺体积较大外。IPSS 从基线时的 20.3（标准差 7.1）降至 12 个月时的 6.3（标准差 4.2）（p<0.001），Aquaablation 和 HoLEP 之间无差异。与 HoLEP 相比，Aquaablation 具有更短的手术时间（59.5（标准差 18.6）vs. 87.2（标准差 14.8）分钟，p<0.001），并在所有时间点均显示出更好的前列腺体积减少效果。术后 3 个月时，Aquaablation 在射精（p=0.02，MSHQ-EjD）和控尿功能（p<0.001，ICIQ-SF）方面的效果更好。3 个月后，Aquaablation 和 HoLEP 之间在勃起功能、射精功能、控尿功能和 LUTS 缓解方面无显著差异。Aquaablation 组有 6 例患者出现 CD≥3b 级并发症，而 HoLEP 组仅 1 例（p=0.01）。
虽然 Aquaablation 在术后 3 个月时在射精和控尿方面显示出暂时的优势，但 HoLEP 在手术时间、安全性和体积结果方面更具优势。
