[铥光纤激光前列腺微创剜除术（MiLEP）：初步结果]

[Minimally invasive enucleation of the prostate (MiLEP) with thulium fiber laser: preliminary results].

作者信息

Petov V S, Dymov A M, Azilgareeva R, Mustafin M A, Enikeev M E, Sukhanov R B, Li Yu A, Chuvalov L L, Tsarichenko D G, Gazimiev M A, Rapoport L M, de Figueiredo F A C

机构信息

Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia of the Ministry of Health of Russia, Moscow, Russia.

N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia of the Ministry of Health of Russia, Moscow, Russia.

出版信息

Urologiia. 2025 Jul(3):28-33.

PMID:40937775

Abstract

INTRODUCTION

Endoscopic enucleation of the prostate is the standard surgical treatment for patients with BPH >80 cc. Despite its efficiency, the incidence of stress urinary incontinence (<6 months) and urethral stricture remains significant at 16.6-29.4% and 1.7-6.5%, respectively. The use of smaller instruments can potentially reduce the rates of these complications.

AIM

This study aims to evaluate the efficiency and safety of minimally invasive laser enucleation of the prostate (MiLEP) using a thulium fiber laser (TFL).

MATERIALS AND METHODS

A prospective study was initiated in March 2024. The inclusion criteria were severe lower urinary tract symptoms (IPSS >20) and/or Qmax <15 ml/s or the necessity for bladder drainage. MiLEP was performed using 22 Ch resectoscope and TFL FIBERLASE U1 and FIBERLASE U-MAX (NTO IRE-Polus, Russia) with the following settings: 1.5 J and 50-55 Hz and 1.7-2 J and 40-45 Hz (DissectPulse). MiLEP technique was en bloc no-touch enucleation with early apical release. Peri- and early postoperative outcomes and complication rates were assessed.

RESULTS

MiLEP was performed in 15 patients with a median age of 67 years (IQR 62.5; 69.5), prostate volume of 61 cc (IQR 46.5; 65.5), and IPSS score was 25.5 (IQR 23.3; 27), Qmax was 5.3 ml/s (IQR 4.5; 9.3). The median duration of the procedure was 42 min (IQR 37; 55), enucleation was 25 min (IQR 21; 28), and morcellation was 7.5 min (IQR 4; 8). Enucleation efficiency was 1.2 g/min (IQR 1; 1.5) and morcellation efficiency was 5.3 g/min (IQR 4.6; 7.7). The median hemoglobin drop was 6.5 g/l (IQR 1.5; 12.8) and the mass of removed tissue was 34 g (IQR 25; 42). The median catheterization and hospitalization time were 2 days (IQR 2; 2.8) and 3 days (IQR 3; 6), respectively. After 1 month, the median IPSS score was 5 (IQR 4; 6; < 0.001), Qmax was 18.7 ml/s (IQR 18; 21; < 0.001). Complications were observed in 5 (33.3%) patients (grade I according to Clavien-Dindo). Stress urinary incontinence occurred in 2 (13.3%) patients on the first day after catheter removal, but in none at 1 month after MiLEP.

CONCLUSION

Minimally invasive enucleation of the prostate with a thulium fiber laser can be considered an effective and safe surgical treatment option for patients with BPH.

摘要

引言

对于前列腺体积大于80立方厘米的良性前列腺增生（BPH）患者，内镜下前列腺剜除术是标准的外科治疗方法。尽管其疗效显著，但压力性尿失禁（<6个月）和尿道狭窄的发生率仍然较高，分别为16.6 - 29.4%和1.7 - 6.5%。使用更小的器械可能会降低这些并发症的发生率。

目的

本研究旨在评估使用掺铥光纤激光器（TFL）进行微创激光前列腺剜除术（MiLEP）的有效性和安全性。

材料与方法

2024年3月开始进行一项前瞻性研究。纳入标准为严重下尿路症状（国际前列腺症状评分[IPSS]>20）和/或最大尿流率（Qmax）<15毫升/秒或需要膀胱引流。使用22F的电切镜以及TFL FIBERLASE U1和FIBERLASE U - MAX（俄罗斯NTO IRE - Polus公司）进行MiLEP，设置如下：1.5焦耳和50 - 55赫兹以及1.7 - 2焦耳和40 - 45赫兹（DissectPulse模式）。MiLEP技术采用整块非接触式剜除并早期进行尖部松解。评估围手术期和术后早期的结果以及并发症发生率。

结果

对15例患者进行了MiLEP，患者中位年龄为67岁（四分位间距[IQR]62.5；69.5），前列腺体积为61立方厘米（IQR 46.5；65.5），IPSS评分为25.5（IQR 23.3；27），Qmax为5.3毫升/秒（IQR 4.5；9.3）。手术中位时长为42分钟（IQR 37；55），剜除时间为25分钟（IQR 21；28），粉碎时间为7.5分钟（IQR 4；8）。剜除效率为1.2克/分钟（IQR 1；1.5），粉碎效率为5.3克/分钟（IQR 4.6；7.7）。血红蛋白中位下降值为6.5克/升（IQR 1.5；12.8），切除组织质量为34克（IQR 25；42）。导尿和住院时间的中位值分别为2天（IQR 2；2.8）和3天（IQR 3；6）。1个月后，IPSS评分中位值为5（IQR 4；6；P<0.001），Qmax为18.7毫升/秒（IQR 18；21；P<0.001）。5例（33.3%）患者出现并发症（根据Clavien - Dindo分级为I级）。2例（13.3%）患者在拔除导尿管后的第一天出现压力性尿失禁，但在MiLEP术后1个月时无患者出现。