Kamalov Armais Albertovich, Sorokin Nikolay Ivanovich, Strigunov Andrey Alekseevich, Nesterova Olga Yurevna, Bondar Ilya Vladimirovich
Academy of the RAS, Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia.
Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia.
Arab J Urol. 2024 Mar 22;22(4):261-267. doi: 10.1080/20905998.2024.2330737. eCollection 2024.
We aimed to evaluate the predictive clinical and operative risk factors for urinary incontinence (UI) rates following thulium fiber enucleation of benign prostate hyperplasia (ThuFLEP).
We conducted a retrospective cohort review of a prospectively maintained database for patients who underwent ThuFLEP between 2021 and 2023 in our university clinic performed by a single surgeon with high experience (more than 3000 endoscopic enucleation). To perform the operation, we used a thulium fiber laser Fiberlase U3 (IRE Polus ltd, Fryazino, Russia) with operating modes of 1.5 J and 40 Hz 60 W. Postoperative UI rates and risk factors following ThuFLEP were assessed for three follow-up intervals (up to 1 months, from 1 to 3 months and after 3 months post-ThuFLEP). Statistical analysis was conducted using univariate and multivariate logistic regression.
Out of total 578 patients who underwent ThuFLEP, the study included 381 patients with full information about continence status. Long-term UI (more than 3 months) were found only in 1.6% cases with 0.8% for stress UI, 0.3% for urge UI and 0.5% for mixed UI. Univariate logistic regression analysis has shown that higher total laser energy (OR = 1.009; 95% CI = 1.001-1.018; = 0.036) and enucleation technique (OR = 0.272; 95% CI = 0.113-0.656; = 0.004 in favor of En-bloc ThuFLEP) were associated with UI overall, while at multivariable analysis only En-bloc ThuFLEP was protective factor for UI (OR = 0.302; 95%CI = 0.123-0.739; = 0.009). For short-term UI (less than 1 months) early sphincter release was found as protective factor at both uni- and multivariate analysis compare to longer UI.
Short-term UI up to 3 months following ThuFLEP is associated with early sphincter release, while overall UI rates are related with enucleation technique (preferable En-bloc) and total laser energy (preferable lower energy). The surgeon should take all these risk factors into account before choosing the technique of BPH surgical treatment.
我们旨在评估良性前列腺增生症铥激光剜除术（ThuFLEP）后尿失禁（UI）发生率的预测性临床和手术风险因素。
我们对一个前瞻性维护的数据库进行了回顾性队列研究，该数据库收录了2021年至2023年在我校诊所由一位经验丰富（超过3000例内镜剜除术）的外科医生进行ThuFLEP手术的患者。为进行手术，我们使用了铥光纤激光器Fiberlase U3（IRE Polus有限公司，俄罗斯弗拉基米尔州弗拉齐诺市），其操作模式为1.5 J和40 Hz 60 W。在三个随访时间段（ThuFLEP术后1个月内、1至3个月以及3个月后）评估ThuFLEP术后的UI发生率和风险因素。使用单因素和多因素逻辑回归进行统计分析。
在总共578例行ThuFLEP手术的患者中，该研究纳入了381例有完整尿失禁状态信息的患者。长期UI（超过3个月）仅在1.6%的病例中出现，其中压力性UI为0.8%，急迫性UI为0.3%，混合性UI为0.5%。单因素逻辑回归分析表明，较高的总激光能量（OR = 1.009；95%CI = 1.001 - 1.018；P = 0.036）和剜除技术（OR = 0.272；95%CI = 0.113 - 0.656；P = 0.004，支持整块ThuFLEP）与总体UI相关，而在多因素分析中，只有整块ThuFLEP是UI的保护因素（OR = 0.302；95%CI = 0.123 - 0.739；P = 0.009）。对于短期UI（少于1个月），与较长时间的UI相比，早期括约肌松解在单因素和多因素分析中均被发现是保护因素。
ThuFLEP术后3个月内的短期UI与早期括约肌松解有关，而总体UI发生率与剜除技术（优选整块）和总激光能量（优选较低能量）有关。外科医生在选择良性前列腺增生症手术治疗技术之前应考虑所有这些风险因素。
