Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
World J Urol. 2024 Oct 9;42(1):569. doi: 10.1007/s00345-024-05271-z.
Holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) are safe and effective treatment options for benign prostatic hyperplasia (BPH). Spinal anesthesia (SA) is widely used for endoscopic enucleation of the prostate (EEP) in place of general anesthesia (GA). We aimed to assess the impact of GA vs. SA on blood loss, postoperative course and functional outcomes after HoLEP and B-TUEP.
After propensity score matching, we analyzed data from 148 patients treated with EEP in our centre for symptomatic BPH. We recorded patient's characteristics, procedural data, type of anesthesia (SA vs. GA). Postoperatively we evaluated hemoglobin drop, catheterization time (CT), and length of hospital stay (LOS). Functional outcomes were evaluated with the International Prostate Symptoms Score (IPSS) at baseline and 3 months after surgery. Descriptive statistics and linear regression models tested the association between anesthesia type and EEP outcomes.
After matching groups were comparable in terms of pre- and intra-operative variables. Of all, 111 (75%) patients were treated under SA. Haemoglobin drop was lower in GA compared to SA group (1 vs. 1.4 g/dL, p < 0.01). CT was shorter in the GA group (1 vs. 2 days, p = 0.01). Postoperative IPSS score was lower in GA group (4 vs. 8, p = 0.04). Multivariable linear regression models revealed that prostate volume (p = 0.01) and SA vs. GA (p = 0.01) were associated with higher haemoglobin drop, after accounting for age and use of anticoagulants/antiplatelets. Similarly, SA vs. GA (p = 0.02) and postoperative complications occurrence (p < 0.001) were associated with a longer LOS, after accounting for age, prostate volume and use of anticoagulants/antiplatelets.
EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes.
钬激光前列腺剜除术（HoLEP）和双极经尿道前列腺剜除术（B-TUEP）是治疗良性前列腺增生（BPH）的安全有效的治疗方法。脊椎麻醉（SA）广泛用于内镜前列腺剜除术（EEP）代替全身麻醉（GA）。我们旨在评估 GA 与 SA 对 HoLEP 和 B-TUEP 后出血量、术后过程和功能结果的影响。
在倾向评分匹配后，我们分析了我们中心 148 例接受 EEP 治疗的有症状 BPH 患者的数据。我们记录了患者的特征、手术数据、麻醉类型（SA 与 GA）。术后我们评估了血红蛋白下降、导尿管留置时间（CT）和住院时间（LOS）。采用国际前列腺症状评分（IPSS）在基线和术后 3 个月评估功能结果。描述性统计和线性回归模型测试了麻醉类型与 EEP 结果之间的关联。
在匹配组中，术前和术中变量具有可比性。所有患者中，111 例（75%）在 SA 下接受治疗。GA 组的血红蛋白下降低于 SA 组（1 与 1.4 g/dL，p < 0.01）。GA 组的 CT 更短（1 与 2 天，p = 0.01）。GA 组术后 IPSS 评分较低（4 与 8，p = 0.04）。多变量线性回归模型显示，前列腺体积（p = 0.01）和 SA 与 GA（p = 0.01）与血红蛋白下降有关，在考虑年龄和使用抗凝剂/抗血小板药物后。同样，SA 与 GA（p = 0.02）和术后并发症的发生（p < 0.001）与 LOS 延长有关，在考虑年龄、前列腺体积和使用抗凝剂/抗血小板药物后。
EEP 可在 GA 和 SA 下安全进行。GA 在围手术期出血和 3 个月功能结果方面提供更好的结果。
