Lim Ee Jean, Herrmann Thomas R W, Castellani Daniele, Fong Khi Yung, Aslim Edwin Jonathan, Biligere Sarvajit, Tursunkulov Azimdjon N, Dellabella Marco, Sancha Fernando Gomez, Sofer Mario, Enikeev Dmitry, Wroclawski Marcelo Langer, Petov Vladislav, Gadzhiev Nariman, Elterman Dean, Mahajan Abhay, Socarras Moises Rodriguez, Yunusov Dilmurod S, Nasirov Furkat, Teoh Jeremy Yuen-Chun, Somani Bhaskar Kumar, Gauhar Vineet
Department of Urology, Singapore General Hospital, Singapore.
Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.
Cent European J Urol. 2025;78(2):137-143. doi: 10.5173/ceju.2024.0060. Epub 2025 May 16.
Anatomical endoscopic enucleation of the prostate (AEEP) is a guideline-recommended treatment for benign prostatic hyperplasia (BPH). We aimed to analyze postoperative complications and outcomes within a large real-world database.
The Refinement in Endoscopic Anatomical enucleation of Prostate (REAP) registry includes patients who received AEEP for BPH in 8 centers worldwide from January 2020 to January 2022. Exclusion criteria included previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, and concomitant lower urinary tract surgery (internal urethrotomy, cystolithotripsy, or transurethral resection of bladder tumor). The primary outcome was postoperative incontinence; secondary outcomes included early complications (<30 days) and late complications (>30 days).
We analyzed 6,193 patients; the mean age was 68 years. Thulium laser was used in 37% and high-power holmium laser in 32%. Median operation time was 67 min [IQR 50-95 min]. The 2-lobe enucleation technique was utilized in 49%, and en-bloc resection was utilized in 39%. Early postoperative complications included urinary tract infection (4.7%), acute urinary retention (4.1%), post-operative bleeding requiring additional intervention (0.9%), and sepsis requiring intensive care admission (0.1%). The incidence of postoperative incontinence was 14.8%, of which 54% were stress incontinence; 84% cases resolved by 3 months. On univariate and multivariate analysis, prostate volume >100 ml was a significant predictor of postoperative incontinence. Late complications such as bulbar urethral stricture, bladder neck sclerosis, and need for redo BPH surgery each occurred in <1% of patients.
Analysis of the real-world REAP database shows favorable safety outcomes for AEEP, with a low incidence of serious complications and postoperative incontinence beyond 3 months.
解剖性前列腺内镜剜除术（AEEP）是良性前列腺增生（BPH）的指南推荐治疗方法。我们旨在分析一个大型真实世界数据库中的术后并发症和结局。
前列腺内镜解剖性剜除术优化（REAP）登记研究纳入了2020年1月至2022年1月期间在全球8个中心接受AEEP治疗BPH的患者。排除标准包括既往前列腺/尿道手术史、前列腺癌、盆腔放疗以及同期下尿路手术（内尿道切开术、膀胱碎石术或经尿道膀胱肿瘤切除术）。主要结局是术后尿失禁；次要结局包括早期并发症（<30天）和晚期并发症（>30天）。
我们分析了6193例患者；平均年龄为68岁。37%的患者使用了铥激光，32%的患者使用了高功率钬激光。中位手术时间为67分钟[四分位间距50 - 95分钟]。49%的患者采用两叶剜除技术，39%的患者采用整块切除。术后早期并发症包括尿路感染（4.7%）、急性尿潴留（4.1%）、需要额外干预的术后出血（0.9%）以及需要重症监护的脓毒症（0.1%）。术后尿失禁的发生率为14.8%，其中54%为压力性尿失禁；84%的病例在3个月内缓解。单因素和多因素分析显示，前列腺体积>100 ml是术后尿失禁的显著预测因素。晚期并发症如球部尿道狭窄、膀胱颈硬化以及再次进行BPH手术的需求在<1%的患者中发生。
对真实世界REAP数据库的分析显示AEEP具有良好的安全性结局，严重并发症和3个月后术后尿失禁的发生率较低。
