Pineda-Murillo J, Hernández-León O, Cuellar Del Río J S, Arellano-Cuadros J R, Martínez-Carrillo G, Quintero-Cortés G A, De la Paz-Martínez S P, Avalos-Ramón J C, Lugo-García J A
Departamento de Urología, Hospital Juárez de México, Ciudad de México, Mexico.
Departamento de Urología, Hospital Juárez de México, Ciudad de México, Mexico.
Actas Urol Esp (Engl Ed). 2025 May;49(4):501745. doi: 10.1016/j.acuroe.2025.501745. Epub 2025 Mar 17.
Benign prostatic enlargement has a prevalence of approximately 60% in 60-year-old men. En bloc enucleation and its variants, which emerged in 2010, are methods to enucleate the three lobes of the prostatic capsule completely, maintaining the capsular plane and the urethral sphincter while removing the prostate. The aim of the present study is to analyze the implementation of the surgical technique, considering the learning curve and the experience accumulated in a group of patients before and after its development.
Retrospective study from July 2022 to November 2024, in which 136 patients with lower urinary tract symptoms due to prostate growth with indication for surgical treatment were included. Bleeding, surgical time, hospital stay, enucleated prostate volume, as well as enucleation, morcellation, time and laser energy efficiencies were analyzed.
The efficacy of the procedure was higher in the post-curve group with a p < 0.0001 compared to the pre-curve group with a coefficient of determination R = 0.8091. Enucleation efficiencies, laser time and energy showed a statistically significant difference (p < 0.05) in favor of the post-curve group.
Holmium laser enucleation of the prostate has proven to be an effective and safe surgical treatment, even during the learning curve. The turning point of the procedure depends on proper mentoring and the appropriate selection of cases during the training process.
良性前列腺增生在60岁男性中的患病率约为60%。整块剜除术及其变体于2010年出现，是一种完全剜除前列腺包膜三个叶的方法，在切除前列腺时保持包膜平面和尿道括约肌。本研究的目的是分析手术技术的实施情况，考虑学习曲线以及该技术发展前后一组患者积累的经验。
对2022年7月至2024年11月进行回顾性研究，纳入136例因前列腺增生导致下尿路症状且有手术治疗指征的患者。分析出血情况、手术时间、住院时间、剜除的前列腺体积，以及剜除、粉碎、时间和激光能量效率。
与曲线前组相比，曲线后组手术效果更高，p<0.0001，决定系数R=0.8091。剜除效率、激光时间和能量在曲线后组有统计学显著差异（p<0.05）。
钬激光前列腺剜除术已被证明是一种有效且安全的手术治疗方法，即使在学习曲线阶段也是如此。该手术的转折点取决于培训过程中的适当指导和病例的恰当选择。
