Urogenital Research Unit of the Department of Anatomy of State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil.
Prostate. 2024 Dec;84(16):1501-1505. doi: 10.1002/pros.24790. Epub 2024 Sep 8.
The objective of the present study is to prospectively analyze the prostate enucleation procedure with Holmium Laser using the minimally invasive technique (MiLEP), comparing the outcomes and their variables pre- and postoperatively.
We studied men aged 40 years or over, with prostate volumes greater than or equal to 35 cm³ with lower urinary tract symptoms due to BPH. We performed flowmetry and administered the IPSS questionnaire before and 6 months after the MiLEP procedure. The patients were operated on with a 60 W Holmium Laser (Cyber-Ho Quanta System®) using 54 W of power (energy 1.8 J and frequency of 30 Hz). Enucleation was performed using the en bloc technique with early sphincter release. After enucleation, the tissue was morcellated using a 22 Fr morcescope (RZ-Medizintechnik GmbH, Tuttlingen, Germany) and Piranha (Richard Wolf) morcellator. The final Hemostasis after morcelation was made using laser with 30wW power, energy at 1,0 joules and frequency at 30 Hertz. Student's T test and Man-Whitney was used to statistical analysis (p < 0.05).
After selection we submitted 73 patients (mean age= 68.2 years) to MiLEP procedure with a follow up of 6 months. The prostate volume presented an average of 94.53 cm³ (65 to 112 cm³, SD = 5.363) preoperatively. The urinary continence rate after the procedure was greater than 95% after 1 week and 99% in the 1st month. All patients were continent after 6 months. The IPSS questionnaire before (mean = 21.18 points/SD = 6.557) and after (mean = 7.92 points/SD = 2.408) the MiLEP had statistical significance (p < 0.001). The flowmetry(ml/s) before (9.02/SD = 2.842) and after (21.07/SD = 6.228) the MiLEP had statistical significance (p < 0.001). The average time of the procedure was 78.5 min and the bladder catheter was removed after 18 h in mean. In 4 patients (5.8%) we observed hematuria and in 1 case (1.47%) the patient needs urinary catheterization.
MiLEP is a safe and effective procedure, with significant improvement in urinary flow and symptoms in the short term. Although the results of this study were satisfactory and the urinary incontinence rate was lower compared to HoLEP data found in the literature, multicenter studies with longer follow-up are needed to confirm these findings.
本研究旨在前瞻性分析使用微创技术（MiLEP）进行钬激光前列腺剜除术，比较术前和术后的结果及其变量。
我们研究了年龄在 40 岁或以上、前列腺体积大于或等于 35cm³且因良性前列腺增生症（BPH）出现下尿路症状的男性。我们在 MiLEP 术前和术后 6 个月进行了流量测定和 IPSS 问卷评估。患者采用 60W 钬激光（Cyber-Ho Quanta System®），功率为 54W（能量 1.8J，频率 30Hz）进行手术。使用早期括约肌松解的整块切除术进行剜除。剜除后，使用 22Fr 碎石镜（RZ-Medizintechnik GmbH，德国图特林根）和 Piranha（Richard Wolf）碎石器进行组织粉碎。粉碎后使用功率为 30wW、能量为 1.0 焦耳、频率为 30 赫兹的激光进行最终止血。使用学生 t 检验和曼-惠特尼进行统计学分析（p<0.05）。
经过选择，我们对 73 名患者（平均年龄=68.2 岁）进行了 MiLEP 手术，随访 6 个月。前列腺体积术前平均为 94.53cm³（65 至 112cm³，标准差=5.363）。术后 1 周尿控率大于 95%，第 1 个月达到 99%。所有患者在 6 个月后均保持尿控。MiLEP 术前（平均=21.18 分/标准差=6.557）和术后（平均=7.92 分/标准差=2.408）的 IPSS 问卷均具有统计学意义（p<0.001）。MiLEP 术前（平均=9.02/标准差=2.842）和术后（平均=21.07/标准差=6.228）的流量（ml/s）均具有统计学意义（p<0.001）。手术平均时间为 78.5 分钟，平均 18 小时后取出膀胱导尿管。4 名患者（5.8%）出现血尿，1 名患者（1.47%）需要导尿。
MiLEP 是一种安全有效的手术方法，可显著改善短期尿流和症状。尽管本研究结果令人满意，尿失禁率低于文献中 HoLEP 数据，但仍需要更长时间随访的多中心研究来证实这些发现。
