Sid Ahmed Momen, Nkwam Nkwam
Urology, Princess Royal University Hospital, Kings College Hospital, London, GBR.
Urology, King's College Hospitals NHS Foundation Trust, London, GBR.
Cureus. 2024 Dec 11;16(12):e75540. doi: 10.7759/cureus.75540. eCollection 2024 Dec.
Hemostasis is a critical aspect of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH). While HoLEP offers superior outcomes compared to traditional techniques, effective intraoperative and postoperative bleeding control remains a challenge. This report evaluates the feasibility and safety of PuraBond® (3-D Matrix, Ltd., Chiyoda-ku, Tokyo), a self-assembling peptide (SAP) hemostatic agent, as an adjunct for hemostasis during HoLEP. A single case study was conducted in August 2024 on a 62-year-old male presenting with lower urinary tract symptoms (LUTSs) and a significantly enlarged prostate (152 cc). The patient underwent en-bloc low-power HoLEP under general anesthesia. Following enucleation and morcellation, initial hemostasis was achieved using bipolar diathermy, and PuraBond® was applied endoscopically to the prostatic fossa. Postoperatively, continuous bladder irrigation was initiated, and the patient was monitored for complications. The total operative time was 120 minutes, with 66 minutes for enucleation and 14 minutes for morcellation. A total of 147.7 g of prostatic tissue was enucleated. Hemostasis was successfully achieved with the combined use of diathermy and PuraBond®, resulting in clear irrigation effluent immediately postoperatively. The patient was discharged the same day without complications. The urinary catheter was removed nine days later, and the urine remained clear throughout the recovery period. At the 28-day follow-up, the patient reported significant symptomatic improvement with no hematuria or irritative urinary symptoms. There were no adverse events or readmissions within three months post-procedure. PuraBond® demonstrated effectiveness and safety as a hemostatic adjunct during HoLEP, providing stable hemostasis and facilitating an uneventful recovery. Its application represents a promising option for managing intraoperative and postoperative bleeding in urological procedures. Further research in larger patient cohorts is warranted to establish its efficacy and broader clinical applicability.
止血是钬激光前列腺剜除术（HoLEP）治疗良性前列腺增生（BPH）的关键环节。虽然与传统技术相比，HoLEP能带来更好的治疗效果，但术中及术后有效控制出血仍是一项挑战。本报告评估了自组装肽（SAP）止血剂PuraBond®（3-D Matrix有限公司，东京千代田区）作为HoLEP术中止血辅助手段的可行性和安全性。2024年8月对一名62岁男性进行了单病例研究，该患者出现下尿路症状（LUTSs）且前列腺显著增大（152立方厘米）。患者在全身麻醉下接受整块低功率HoLEP手术。在剜除和粉碎术后，使用双极电凝实现初步止血，并通过内镜将PuraBond®应用于前列腺窝。术后开始持续膀胱冲洗，并对患者进行并发症监测。总手术时间为120分钟，其中剜除时间为66分钟，粉碎时间为14分钟。共剜除前列腺组织147.7克。通过电凝和PuraBond®联合使用成功实现了止血，术后立即出现清澈的冲洗液。患者当天出院，无并发症发生。九天后拔除导尿管，恢复期间尿液一直清澈。在28天的随访中，患者报告症状有显著改善，无血尿或刺激性尿路症状。术后三个月内无不良事件或再次入院情况。PuraBond®在HoLEP术中作为止血辅助剂显示出有效性和安全性，提供了稳定的止血效果并促进了平稳恢复。其应用是管理泌尿外科手术中术中及术后出血的一个有前景的选择。有必要在更大的患者队列中进行进一步研究，以确定其疗效和更广泛的临床适用性。
