Iscaife Alexandre, Socarrás Moises Rodríguez, Talizin Thalita Bento, Nahas Willian Carlos, Del Alamo Julio Fernandez, Rivera Vanesa Cuadros, Gómez Sancha Fernando, Socarrás Moisés Rodríguez
Instituto de Cirugía Urológica Avanzada (ICUA) Clínica CEMTRO, Madrid, Spain.
University of Sao Paulo Medical School-FMUSP, São Paulo, Brasil.
World J Urol. 2025 Jun 30;43(1):401. doi: 10.1007/s00345-025-05765-4.
The aim of this study was to compare patients undergoing En Bloc HoLEP with early apical release and sphincter preservation, accordingly to prostate size regarding perioperative data and postoperative evolution.
754 patients were studied and divided into 2 groups: prostate ≤ 120 g (644 patients) and prostate ≥ 120 g, (110 patients). Surgeries were performed by a single surgeon (Fernando Gómez Sancha) using a 150 W high power Holmium laser (Quanta SpA, Samarate, Italy), The technique was En-Bloc with early apical release and sphincter preservation. Prostate volume, PSA, Q max, IPSS among other parameters were assessed before surgery and 3, 6 and 12 months after the procedure. Urinary incontinence (UI) was defined as any leakage reported by patients; classified by duration (< 1 month, 1-3 months, and > 3 months) and type (urge, stress, or mixed).
The mean age was 67.2 years 67.2 years (± 8,4). Enucleation time was longer in the larger prostate group (40.0 vs. 25.0 min, p < 0.0001), as well as morcellation time (13.0 vs. 5.0 min, p < 0.0001). Enucleation (3.1 vs. 1.9 g/min, p < 0.0001) and morcellation efficiency (7.7 vs. 1.5 g/min, p = 0.0015) were higher in the large prostate group. At 6 months the incidence of STUI was extremely low without difference between groups (0.9% vs. 0.15%, p = 0.27).
In conclusion, the study shows that the En-Bloc technique with early release and sphincter preservation has excellent continence results and low complication rates even for prostates larger than 120 g. Technical refinement and care with apical enucleation should be one of the fundamental axes of the training and development of surgeons in performing HoLEP, especially in large prostates.
本研究旨在比较接受整块剜除术（En Bloc HoLEP）并早期进行尖部松解和保留括约肌的患者，根据前列腺大小分析围手术期数据和术后恢复情况。
对754例患者进行研究并分为两组：前列腺≤120g（644例患者）和前列腺≥120g（110例患者）。手术由单一外科医生（费尔南多·戈麦斯·桑查）使用150W高功率钬激光（意大利撒马腊的Quanta SpA公司）进行，采用整块切除并早期进行尖部松解和保留括约肌的技术。在手术前以及术后3个月、6个月和12个月评估前列腺体积、前列腺特异性抗原（PSA）、最大尿流率（Q max）、国际前列腺症状评分（IPSS）等参数。尿失禁（UI）定义为患者报告的任何漏尿情况；按持续时间（<1个月、1 - 3个月和>3个月）和类型（急迫性、压力性或混合性）进行分类。
平均年龄为67.2岁（±8.4岁）。较大前列腺组的剜除时间更长（40.0分钟对25.0分钟，p<0.0001），粉碎时间也更长（13.0分钟对5.0分钟，p<0.0001）。较大前列腺组的剜除效率（3.1克/分钟对1.9克/分钟，p<0.0001）和粉碎效率（7.7克/分钟对1.5克/分钟，p = 0.0015）更高。在6个月时，短暂性尿失禁（STUI）的发生率极低，两组之间无差异（0.9%对0.15%，p = 0.27）。
总之，该研究表明，即使对于大于120g的前列腺，采用早期松解和保留括约肌的整块切除技术也能取得优异的控尿效果且并发症发生率低。技术改进以及对尖部剜除的谨慎操作应是开展HoLEP手术的外科医生培训与发展的基本要点之一，尤其是在处理较大前列腺时。
