Harraz Ahmed M, Aldousari Saad, Eltafahny Abdelrahman I, Almoumen Ali, Thahir Awad, Ajrawi Feras, Alarbid Abdullah, Alghurair Ahmad, Alghanem Mohammad, Alhajeri Faisal
Farwaniya Hospital, Farwaniya, Kuwait.
Sabah Al Ahmad Urology Center, Kuwait City, Kuwait.
Low Urin Tract Symptoms. 2025 Jan;17(1):e70006. doi: 10.1111/luts.70006.
During holmium laser enucleation of the prostate (HOLEP), blunt dissection (BD) by pushing the tip of the scope may exert mechanical force on the sphincter that could be avoided by adopting laser dissection (LD). This study evaluates the continence recovery in consecutive patients who underwent BD and LD.
A prospective cohort of patients who underwent LD was compared with a retrospective control that underwent BD. In both groups, early apical release was performed, and the adenoma was split at 12 O'clock after complete enucleation. In LD, a trans-capsular plane was sharply created by LD and is guided by the circular capsular fibers. A mechanical push with the resectoscope tip was used to create and maintain the ideal surgical plane in the BD group while the laser energy was used to achieve timely hemostasis. The primary outcome was stress urinary incontinence (SUI), defined as the need to use any number of pads, immediately after catheter removal, at 1 week and 1 month postoperatively.
Consecutive 51 (48.6%) and 54 (51.4%) patients underwent BD and LD, respectively. The LD group tends to be older while other demographics were comparable. Both groups were comparable regarding the estimated prostate volume, enucleation time, and postoperative resolution of symptoms. Continence recovery was in favor of the LD group immediately after removing the catheter (77.8% vs. 43.1%; p < 0.001), at 1 week (92.6% vs. 66.7%; p = 0.002), with no significant difference at 1 month (98.1% vs. 88.2%; p = 0.06).
LD tends to have favorable early continence recovery compared with BD mostly because of less mechanical stress. Minimizing the periods of blunt pushes during the enucleation might benefit continence recovery.
在钬激光前列腺剜除术（HOLEP）中，通过推动镜尖进行钝性分离（BD）可能会对括约肌施加机械力，而采用激光分离（LD）则可避免这种情况。本研究评估了接受BD和LD的连续患者的控尿功能恢复情况。
将接受LD的前瞻性队列患者与接受BD的回顾性对照组进行比较。两组均进行早期尖部松解，并在完全剜除后于12点处劈开腺瘤。在LD组中，通过LD锐性建立经包膜平面，并以环状包膜纤维为导向。BD组使用电切镜尖端进行机械推压以建立和维持理想的手术平面，同时使用激光能量实现及时止血。主要结局指标为压力性尿失禁（SUI），定义为术后拔除导尿管后即刻、术后1周和1个月时需要使用任何数量的尿垫。
结果：分别有51例（48.6%）和54例（51.4%）患者接受了BD和LD。LD组患者年龄偏大，而其他人口统计学特征具有可比性。两组在估计前列腺体积、剜除时间和术后症状缓解方面具有可比性。拔除导尿管后即刻（77.8%对43.1%；p<0.001）、1周时（92.6%对66.7%；p=0.002），控尿功能恢复情况有利于LD组，1个月时无显著差异（98.1%对88.2%；p=0.06）。
与BD相比，LD在早期控尿功能恢复方面往往更具优势，主要原因是机械应力较小。在剜除过程中尽量减少钝性推压的时间可能有利于控尿功能的恢复。
