Dibiraliev C D, Markosyan G T, Olefir Yu V, Dymov A M, Sukhanov R B, Bezrukov E A, Gazimiev M A
Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Urologiia. 2025 May(2):141-146.
To compare the incidence of postoperative stress urinary incontinence (SUI) in patients with benign prostatic hyperplasia after three different techniques of thulium fiber laser prostate enucleation (ThuFLEP): two-lobe, enucleation of all lobes in a single block (en-bloc) and enucleation of all lobes in a single block without additional longitudinal incisions (total en-bloc).
A retrospective and prospective comparative analysis included 472 patients, who were undergone to three different techniques of ThuFLEP. The surgical interventions were performed by three experienced surgeons from January 2015 to May 2023. The incidence of postoperative stress urinary incontinence (SUI), risk factors for SUI, and the rate of improvement in patients with SUI were evaluated. The patients were examined pre- and postoperatively.
Logistic regression analysis was used to assess the effect of two main predictors, surgical technique and prostate volume, on the SUI after the surgical procedure. The postoperative SUI developed in 49 (10.4%) patients. After 6 months, SUI persisted in only 6 (1,3%) cases. Uni- and multivariate analysis of these predictors was performed. Depending on the technique of laser enucleation, the incidence of SUI reached 13.9% after the two-lobe technique, 12.4% after the en-bloc technique, and 5.4% after the total en-bloc technique. In addition, the total en-bloc technique proved an earlier restoration of urinary continence after laser enucleation. Uni- and multivariate analysis showed the significant influence of the surgical technique on the SUI (p=0.013 for the univariate analysis, p=0.046 for the multivariate analysis).
We confirmed the significant reduction of the postoperative SUI in the first six months when used the total en-bloc technique with additional beneficial effect on early recovery of urinary continence.
比较良性前列腺增生患者在接受三种不同的铥光纤激光前列腺�前列腺剜除术（ThuFLEP）技术后发生术后压力性尿失禁（SUI）的发生率，这三种技术分别为：两叶剜除术、整块剜除所有叶（整块剜除）以及整块剜除所有叶且无额外纵向切口（完全整块剜除）。
一项回顾性和前瞻性对比分析纳入了472例行三种不同ThuFLEP技术的患者。手术干预由三位经验丰富的外科医生于2015年1月至2023年5月进行。评估术后压力性尿失禁（SUI）的发生率、SUI的危险因素以及SUI患者的改善率。对患者进行术前和术后检查。
采用逻辑回归分析评估手术技术和前列腺体积这两个主要预测因素对手术后SUI的影响。49例（10.4%）患者发生了术后SUI。6个月后，仅6例（1.3%）患者仍存在SUI。对这些预测因素进行单因素和多因素分析。根据激光剜除技术，两叶剜除术后SUI发生率达13.9%，整块剜除术后为12.4%，完全整块剜除术后为5.4%。此外，完全整块剜除技术被证明在激光剜除术后尿失禁恢复更早。单因素和多因素分析显示手术技术对SUI有显著影响（单因素分析p = 0.013，多因素分析p = 0.046）。
我们证实，采用完全整块剜除技术可使术后前六个月的SUI显著减少，并对尿失禁的早期恢复有额外益处。
