Efficacy of Thulium laser enucleation-resection of prostate for benign prostatic hyperplasia with large gland
Objective To explore the treatment experience of Thulium laser enucleation-resection of prostate(ThuLERP)for benign prostatic hyperplasia(BPH)with large gland.Methods The clinical data of 154 BPH patients with large gland(prostate volume＞80 ml)were analyzed retrospectively from December 2018 to January 2022.Seventy-seven patients underwent ThuLERP and 77 patients underwent ThuLERP and 77 patients received Thulium laser enucleation of prostate(ThuLEP).There were no significant differences between both groups(P＞0.05)in term of the age[(71.3±15.3)years old vs.(67.5±15.1)years old],Qmax[(9.5±3.5)ml/s vs.(8.9±2.4)ml/s],IPSS[(20.5±3.6)vs.(21.7±3.4)],QOL[(4.6±1.1)vs.(4.4±1.5)],postvoid residual volume[(124.7±24.3)ml vs.(130.2±22.4)ml],PSA[(2.7±1.3)ng/ml vs.(2.9±1.5)ng/ml]and prostate volume[(108.1±21.1)ml vs.(116.0± 24.7)ml].Both groups were treated with a three-lobe technique.ThuLERP was performed using anatomical enucleation combined with vaporization cut technique.The glands were bluntly dissected to established the surgical capsule plane on both sides of the verumontanum.At first,the middle lobe was bluntly enucleated;Secondly,left and right lobe were bluntly enucleated to 3 o'clock and 9 o clock,respectively;Thirdly,the glands formed grooves at 12 o'clock after vaporization,which served as anatomical marker;At last,left and right lobe were resected using laser from 3 o'clock to 12 o'clock and 9 o'clock to 12 o'clock,respectively.ThuLEP was performed using anatomical enucleation technique.Efficacy and postoperative complications of the two groups were compared.Results The difference between ThuLERP group and ThuLEP group in enucleation time[(51±11.3)min vs.(65.4±13.5)min]and operation time[(62.5±20.4)min vs.(78.5±19.8)min]were statistically significant(P＜0.05).However,the difference between both groups in glandular weight of enucleation[(63.4±14.2)g vs.(71.5±21.5)g],hemoglobin decrease[(9.1± 3.7)g/L vs.(8.5±3.5)g/L],postoperative hospital stay[(1.3±0.2)d vs.(1.4±0.5)d]and catheter indwelling duration[(2.5±1.5)d vs.(2.8±1.9)d]were not statistically significant(P＞0.05).All patients were followed up for 6 months after surgery.In both groups,postoperative IPSS were 5.6±2.2 vs.6.7±1.4,QOL 1.6±0.4 vs.2.1±0.8,Qmax(27.6±10.2)ml/s vs.(29.5±14.7)ml/s,and postvoid residual volume(10.3±5.5)ml vs.(7.9±3.7)ml,respectively,which were significantly different from that of the pre-operation(P＜0.05).However,there was not significant different between the two groups(P＞0.05).The postoperative immediate urinary continence rate in ThuLERP group and ThuLEP group were 97.4％(75/77)and 88.3％(68/77),respectively,and two groups had statistical differences(P＜0.05).Urinary continence rate in both groups was 100％at 3 months after surgery.Conclusions ThuLERP was the same effective as ThuLEP in the treatment of BPH with large gland,and it could significantly reduce operation time and improve immediate urinary continence rate.
Benign prostate hyperplasiaEnucleation of prostateResection of prostateThulium laserEffect
万方数据
