微创钬激光前列腺剜除术（MiLEP）与钬激光前列腺剜除术（HoLEP）：倾向评分匹配队列围手术期结果的回顾性分析

Minimally Invasive Holmium Laser Enucleation of the Prostate (MiLEP) Vs. HoLEP: Retrospective Analysis of Perioperative Outcomes in a Propensity Score-Matched Cohort.

作者信息

Schmidt Jacob, Ralla Bernhard, Maxeiner Andreas, Krediet Jorien, Beutel Holger, Allah Ayoub Hidayat, Gagel Nella, Plage Henning, Ullmann Maha, Peters Robert, Friedersdorff Frank, Kanne Martin

机构信息

Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany.

Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.

出版信息

Prostate. 2025 Oct;85(14):1299-1306. doi: 10.1002/pros.70016. Epub 2025 Jul 16.

DOI:10.1002/pros.70016

PMID:40671245

Abstract

BACKGROUND

Holmium laser enucleation of the prostate (HoLEP) is a well-established, size-independent surgical treatment offering favorable perioperative outcomes. Recently, minimal invasive laser enucleation of the prostate (MiLEP) has been introduced as a miniaturized approach utilizing a 22 Fr endoscope. However, comparative perioperative data on MiLEP versus HoLEP remain scarce.

MATERIALS AND METHODS

A retrospective propensity-matched (PSM) cohort analysis was conducted, comparing the perioperative outcomes of the first 100 MiLEPs performed at our center versus standard HoLEP. After the PSM of 2187 patients, data from 200 patients (HoLEP: n = 100, MiLEP: n = 100) treated at a high-volume laser center were analyzed. Key parameters included operative time, enucleated tissue volume, complication rates, and catheterization duration. Statistical significance was set at p < 0.05.

RESULTS

Demographic characteristics, overall operative (36 vs. 35 min, p = 0.87), and enucleation times (22 vs. 23 min, p = 0.68) were comparable between MiLEP and HoLEP. However, MiLEP showed significantly shorter median morcellation times (5 vs. 3 min, p = 0.03), while coagulation time was longer (6 vs. 5 min, p = 0.02). Overall, complication rates were similar between both groups (15% vs. 16%, p = 0.85), with similar Clavien-Dindo distributions (Grade II: 13% vs. 11%; Grade IIIb: 2% in both groups). Recatheterization (8% vs. 4%, p = 0.23), macrohematuria requiring prolonged catheterization (1% vs. 5%, p = 0.1), and postoperative fever (4% vs. 5%, p = 0.73) showed no significant differences and were size-independent across prostates < 30, 30-59, and > 60 mL.

CONCLUSION

Implementation of MiLEP is safe and feasible in a center with HoLEP experience, demonstrating comparable perioperative outcomes. The miniaturized approach maintains surgical efficiency across different prostate sizes while reducing instrument size. Further studies are necessary to evaluate long-term functional outcomes and confirm the potential benefits of MiLEP regarding urethral trauma.

摘要

背景

钬激光前列腺剜除术（HoLEP）是一种成熟的、不受前列腺大小限制的手术治疗方法，围手术期效果良好。最近，微创激光前列腺剜除术（MiLEP）作为一种采用22 Fr 内窥镜的小型化方法被引入。然而，关于MiLEP与HoLEP的比较围手术期数据仍然稀少。

材料与方法

进行了一项回顾性倾向匹配（PSM）队列分析，比较了在我们中心进行的前100例MiLEP与标准HoLEP的围手术期结果。在对2187例患者进行PSM后，分析了在一个高容量激光中心治疗的200例患者（HoLEP：n = 100，MiLEP：n = 100）的数据。关键参数包括手术时间、剜除组织体积、并发症发生率和导尿持续时间。统计学显著性设定为p < 0.05。

结果

MiLEP和HoLEP之间的人口统计学特征、总体手术时间（36对35分钟，p = 0.87）和剜除时间（22对23分钟，p = 0.68）具有可比性。然而，MiLEP的中位粉碎时间显著更短（5对3分钟，p = 0.03），而凝血时间更长（6对5分钟，p = 0.02）。总体而言，两组的并发症发生率相似（15%对16%，p = 0.85），Clavien-Dindo分布相似（II级：13%对11%；IIIb级：两组均为2%）。再次导尿（8%对4%，p = 0.23）、需要延长导尿时间的大出血（1%对5%，p = 0.1）和术后发热（4%对5%，p = 0.73）均无显著差异，且在前列腺体积<30 mL、30 - 59 mL和>60 mL的患者中与前列腺大小无关。