Endo Fumiyasu, Shimbo Masaki, Komatsu Kenji, Ohwaki Kazuhiro, Hattori Kazunori
Department of Urology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan.
Department of Hygiene and Public Health, Teikyo University School of Medicine Graduate School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
Asian J Urol. 2024 Jul;11(3):423-428. doi: 10.1016/j.ajur.2023.04.005. Epub 2023 Sep 22.
The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate, investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency, and seek to determine the optimal interval between the two surgeries.
This study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g, indicative of substantial prostate enlargement. Morcellation was performed on Day 0 (=4), Day 4 (=1), Day 6 (=1), and Day 7 (=3). The intervals were compared regarding the morcellation efficiency, beach ball presence, and pathology.
The mean estimated prostate volume was 383 (range 330-528) mL; the median enucleation weight was 252 (interquartile range [IQR] 222, 342) g; and the median enucleation time was 83 (IQR 62, 100) min. The mean morcellation efficiency was 1.44 (SD 0.55) g/min on Day 0 and 13.69 (SD 2.46) g/min on day 7. The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6, respectively, with significantly higher in the two-stage group compared to one-stage group (11.0 g/min 1.5 g/min; =0.014). Efficiency was strongly correlated with intervals (<0.001); the incidences of beach balls were 100% (4/4) and 60% (3/5) in the immediate and two-stage surgery groups, respectively.
The efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval, with the maximum efficiency reached on Day 7.
本研究旨在评估在钬激光前列腺剜除术中使用往复式粉碎术切除巨大良性前列腺增生的效率，探讨分两阶段进行粉碎术是否能提高组织取出效率，并确定两次手术之间的最佳间隔时间。
本研究纳入9例钬激光前列腺剜除术患者，其剜除的前列腺重量超过200 g，表明前列腺明显增大。分别在第0天（=4例）、第4天（=1例）、第6天（=1例）和第7天（=3例）进行粉碎术。比较不同间隔时间的粉碎效率、“沙滩球”出现情况及病理结果。
估计前列腺平均体积为383（范围330 - 528）mL；剜除重量中位数为252（四分位间距[IQR] 222, 342）g；剜除时间中位数为83（IQR 62, 100）分钟。第0天的平均粉碎效率为1.44（标准差0.55）g/分钟，第7天为13.69（标准差2.46）g/分钟。第4天和第6天的粉碎效率分别为4.15 g/分钟和10.50 g/分钟，两阶段组明显高于一阶段组（11.0 g/分钟对1.5 g/分钟；P = 0.014）。效率与间隔时间密切相关（P < 0.001）；即刻手术组和两阶段手术组“沙滩球”发生率分别为100%（4/4）和60%（3/5）。
使用往复式粉碎器进行两阶段粉碎术的效率与术后间隔时间高度相关，在第7天达到最高效率。
