Schmidt Jacob, Krediet Jorien, Beutel Holger, Hidayat Allah Ayoub, Gagel Nella, Lichy Isabel, Ralla Bernhard, Ullmann Maha, Peters Robert, Friedersdorff Frank, Kanne Martin
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Urology, Hindenburgdamm 30, 12203 Berlin, Germany.
Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
Eur Urol Open Sci. 2024 Nov 18;71:15-21. doi: 10.1016/j.euros.2024.10.019. eCollection 2025 Jan.
Our objective was to evaluate whether a very large prostate volume significantly affects the incidence of perioperative complications and compromises outcomes among patients undergoing holmium laser enucleation of the prostate (HoLEP).
We retrospectively analyzed data for 1815 adult patients who underwent HoLEP at Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, between January 2019 and May 2024. Patients were divided into two groups according to their prostate volume: ≤149 ml (group A) and ≥150 ml (group B). Propensity score matching on age, body mass index, American Society of Anesthesiologists physical status, and the presence of an indwelling catheter was used to balance baseline differences. A Mann-Whitney test was used for comparison of continuous variables between the groups, and a χ test for comparison of categorical variables, with < 0.05 considered statistically significant. Postoperative complications were assessed according to the Clavien-Dindo classification.
After propensity score matching, 163 matched cases per group were analyzed. Group B had significantly longer median total operative time (76 vs 47 min; < 0.001), enucleation time (42 vs 26 min; < 0.001), coagulation time (11 vs 6 min; < 0.001), and morcellation time (15 vs 7 min; < 0.001). Clavien-Dindo grade ≥IIIb complications (8.7% vs 1.2%; = 0.02) and blood transfusion (2.5% vs 0%; = 0.045) were significantly more frequent in group B. Catheterization time (1.9 vs 2.0 d; = 0.01) and the proportion of patients with postoperative residual urine volume ≤50 ml (85.2% vs 80.2%; = 0.18) were comparable between the groups. Limitations include the retrospective and single-center study design.
Prostate volume ≥150 ml is associated with a longer operative time, a higher rate of major complications, and a more frequent need for blood transfusion. Therefore, HoLEP for prostate glands ≥150 ml should be performed in experienced high-volume centers.
We compared outcomes of laser surgery for enlarged prostate glands of different sizes. We found that while the surgery is generally effective for very large prostates, it takes longer and has a higher risk of complications in comparison to more typical prostate sizes. However, this procedure is still the best treatment available for prostate enlargement and should be carried out in high-volume hospitals specializing in this treatment.
我们的目的是评估前列腺体积非常大是否会显著影响接受钬激光前列腺剜除术（HoLEP）患者的围手术期并发症发生率并影响手术结果。
我们回顾性分析了2019年1月至2024年5月期间在柏林伊丽莎白女王赫尔茨贝格福音医院接受HoLEP的1815例成年患者的数据。根据前列腺体积将患者分为两组：≤149 ml（A组）和≥150 ml（B组）。采用倾向评分匹配法，根据年龄、体重指数、美国麻醉医师协会身体状况分级以及留置导尿管情况来平衡基线差异。两组间连续变量的比较采用Mann-Whitney检验，分类变量的比较采用χ检验，P<0.05被认为具有统计学意义。术后并发症根据Clavien-Dindo分类进行评估。
倾向评分匹配后，每组分析163例匹配病例。B组的中位总手术时间（76 vs 47分钟；P<0.001）、剜除时间（42 vs 26分钟；P<0.001）、凝血时间（11 vs 6分钟；P<0.001）和粉碎时间（15 vs 7分钟；P<0.001）显著更长。B组Clavien-Dindo≥IIIb级并发症（8.7% vs 1.2%；P=0.02）和输血发生率（2.5% vs 0%；P=0.045）显著更高。两组间导尿时间（1.9 vs 2.0天；P=0.01）以及术后残余尿量≤50 ml的患者比例（85.2% vs 80.2%；P=0.18）相当。局限性包括回顾性单中心研究设计。
前列腺体积≥150 ml与手术时间延长、主要并发症发生率更高以及输血需求更频繁相关。因此，对于前列腺体积≥150 ml的患者，HoLEP应在经验丰富的大容量中心进行。
我们比较了不同大小前列腺增生的激光手术结果。我们发现，虽然该手术对非常大的前列腺一般有效，但与更典型的前列腺大小相比，手术时间更长且并发症风险更高。然而，该手术仍是前列腺增生的最佳治疗方法，应在专门从事该治疗的大容量医院进行。
