Pirola Giacomo Maria, Castellani Daniele, Naselli Angelo, Fong Khi Yung, Biligere Sarvajit, Dellabella Marco, Gasparri Luca, Cormio Angelo, Yuen Steffi Kar-Kei, Somani Bhaskar K, Giulioni Carlo, Gómez Sancha Fernando, Enikeev Dmitry, Sofer Mario, Chiruvella Mallikarjuna, Bendigeri Mohammed Taif, Tursunkulov Azimdjon N, Mahajan Abhay, Bhatia Tanuj Paul, Ivanovich Sorokin Nikolai, Gadzhiev Nariman, Ying Lie Kwok, Petov Vladislav, Herrmann Thomas R W, Gauhar Vineet
Department of Urology, San Giuseppe Hospital, IRCCS Multimedica, Milano, Italy.
Department of Urology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, Ancona, 60126, Italy.
World J Urol. 2025 May 31;43(1):344. doi: 10.1007/s00345-025-05699-x.
To provide the outcomes from a multicentric series of men aged 80 years and above, understand the feasibility of endoscopic enucleation of the prostate (EEP), and compare different energy sources and techniques.
We extracted data on patients who underwent EEP in 15 Centers (January 2019-January 2023). Continuous variables are expressed as medians and interquartile ranges while categorical variables as absolute numbers and percentages. A multivariable logistic regression analysis was performed to identify predictors of overall postoperative incontinence and reported as odds ratio (OR) and 95% confidence interval (CI).
731 patients were included. Median age was 82 years and median prostate volume (PV) was 90 cc. 33.1% of participants had PV ≤ 80 ml, 28.4%. between 81 and 100 ml, 36.7% between 101 and 200 ml, and 1.8% of more than 200 ml. Median International Prostate Symptom Score was 23 [20-26]. EEP was mainly performed with the en-bloc technique (367 cases, 50.3% of the total). Total median operation time was 80 min [60-110]. Postoperative urinary incontinence was reported in 113 patients (15.5%). Complication rate was low with only 16 patients (2.2%) suffering from major complications (sepsis: 1 case; bleeding requiring surgical control: 13 cases; secondary morcellation: 2 cases). At multi-variable analysis, PV > 200 ml was significantly associated with higher odds of incontinence (OR 5.84 95% CI 1.76-18.96), whilst en-bloc enucleation with lower odds (OR 0.51 95% CI 0.32-0.80).
EEP in men aged 80 years and above is a safe, efficacious, and size-independent procedure. In glands larger than 200 ml there may be a prolonged period of incontinence, mainly stress-related. En-bloc enucleation may be a better approach to minimize early urinary incontinence.
提供一组80岁及以上男性患者的多中心研究结果，了解前列腺内镜剜除术（EEP）的可行性，并比较不同能量源和技术。
我们提取了15个中心（2019年1月至2023年1月）接受EEP治疗患者的数据。连续变量以中位数和四分位数间距表示，分类变量以绝对数和百分比表示。进行多变量逻辑回归分析以确定总体术后尿失禁的预测因素，并报告为比值比（OR）和95%置信区间（CI）。
纳入731例患者。中位年龄为82岁，中位前列腺体积（PV）为90立方厘米。33.1%的参与者PV≤80毫升，28.4%在81至100毫升之间，36.7%在101至200毫升之间，1.8%超过200毫升。国际前列腺症状评分中位数为23[20-26]。EEP主要采用整块切除技术（367例，占总数的50.3%）。总中位手术时间为80分钟[60-110]。113例患者（15.5%）报告有术后尿失禁。并发症发生率较低，只有16例患者（2.2%）发生严重并发症（脓毒症：1例；需要手术控制的出血：13例；二次粉碎术：2例）。在多变量分析中，PV>200毫升与尿失禁几率较高显著相关（OR 5.84，95%CI 1.76-18.96），而整块剜除术的几率较低（OR 0.51，95%CI 0.32-0.80）。
80岁及以上男性的EEP是一种安全、有效的手术，且与前列腺大小无关。对于大于200毫升的腺体，可能会有较长时间的尿失禁期，主要与压力性尿失禁有关。整块剜除术可能是减少早期尿失禁的更好方法。
