Gao Zhixiang, Ding Yue, Liu Haiyong, Du Renji, Sun Zhiwei, Xu Li, Gu Lijuan, Wang Ping, Wang Rong
Department of Urology, Zhangjiagang Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China.
Department of Urology, Jintan Affiliated Hospital of Jiangsu University, Changzhou, China.
J Int Med Res. 2024 Dec;52(12):3000605241304542. doi: 10.1177/03000605241304542.
To compare the safety and efficacy of low-power (LP) and high-power (HP) holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic small-volume benign prostatic hyperplasia (BPH).
In this prospective, multicenter, single-blind, randomized controlled trial, men with symptomatic BPH (prostate volume <40 mL, peak urinary flow rate [Qmax] <10 mL/s, International Prostate Symptom Score [IPSS] ≥18) underwent either LP (24 W) or HP HoLEP (80 W). The primary outcome was IPSS at 6 months postoperatively. Secondary outcomes included the surgical duration, total laser energy, enucleated prostate weight, patient-reported outcomes, and Clavien-Dindo classification of complications at 1, 3, and 6 months after surgery.
Eighty-one participants completed the study. LP HoLEP used significantly less energy (22.4 ± 10.4 kJ vs. 58.6 ± 17.8 kJ). Postoperative pain was lower in the LP group at 24 and 48 hours. Both groups displayed significant improvements in outcomes versus baseline including IPSS and Qmax. The incidence of intraoperative complications was similar, though minor capsular perforation occurred exclusively in the HP group (9.8%).
LP HoLEP produced comparable clinical outcomes as HP HoLEP for small-volume BPH while using less energy, supporting its use for smaller glands.
比较低功率（LP）和高功率（HP）钬激光前列腺剜除术（HoLEP）治疗有症状的小体积良性前列腺增生（BPH）患者的安全性和有效性。
在这项前瞻性、多中心、单盲、随机对照试验中，有症状的BPH患者（前列腺体积<40 mL，最大尿流率[Qmax]<10 mL/s，国际前列腺症状评分[IPSS]≥18）接受LP（24 W）或HP HoLEP（80 W）治疗。主要结局是术后6个月时的IPSS。次要结局包括手术时间、总激光能量、剜除的前列腺重量、患者报告的结局以及术后1、3和6个月时并发症的Clavien-Dindo分类。
81名参与者完成了研究。LP HoLEP使用的能量明显更少（22.4±10.4 kJ对58.6±17.8 kJ）。LP组在术后24小时和48小时的疼痛较轻。与基线相比，两组在包括IPSS和Qmax在内的结局方面均有显著改善。术中并发症的发生率相似，不过小的包膜穿孔仅发生在HP组（9.8%）。
对于小体积BPH，LP HoLEP产生的临床结局与HP HoLEP相当，同时使用的能量更少，支持其用于较小的腺体。
