The efficiency and safety of"U-shape"en bloc enucleation technique in Thulium fiber laser enucleation and resection of prostate
Objective To investigate the therapeutic effectiveness and safety of"U shape"en bloc Thulium fiber laser enucleation and resection of the prostate(ThuLERP)technique.Methods The clinical data of 105 benign prostatic hyperplasia(BPH)patients treated by a single surgeon in Peking University First Hospital from January to October 2022 were retrospectively reviewed.Among them,50 patients underwent"U-shaped"en bloc technique prostate enucleation(UEBT),and 55 patients underwent prostate lobe removal using the lobe technique(LT).There were no significant differences between UEBT and LT groups(P＞0.05)in term of the age[(69.1±6.9)years old vs.(68.8±9.1)years old],international prostate symptom score(IPSS)[(22.7±1.9)vs.(22.8±2.7)]and maximum flow rate(Qmax)[(9.0±3.7)ml/s vs.(9.3±4.3)ml/s].The prostate-specific antigen(PSA)of UEBT group was higher than that of LT group[7.52(3.05,8.76)ng/ml vs.6.78(1.61,7.45)ng/ml],and the prostate volume of the UEBT group was larger than that of LT group[(103.49±46.19)ml vs.(75.73±30.69)ml,all P＜0.05].In the UEBT group,the apical of prostate was bluntly enucleated with pre-transection urethral mucosa at the apex of prostate technique.Secondly,glands formed grooves at 12 o'clock after vaporization,which served as anatomical marker.At last,the whole lobe which was like"U shape"were resected using laser.In the LT group,glands was divided to three lobe,the middle,the left and the right lobe was bluntly enucleated respectively.Perioperative data,postoperative complications and clinical outcomes were compared between the two groups.Correlation between enucleation efficiency and enucleation weight was analysed using linear regression.Results There were no significant differences between the UEBT and LT group(P＞0.05)in term of morcellation time[18(9,34)min vs.16(8,28)min],resection rate[(0.5±0.1)g/ml vs.(0.5±0.1)g/ml],catheter indwelling duration[(3.8±1.4)d vs.(3.6±1.1)d]and hospitalization stay[(4.1±0.3)d vs.(3.9±0.8)d].The difference between the UEBT group and LT group in operation time[54(42,100)min vs.80(60,150)min],enucleated time[37(26,75)min vs.47(31,69)min],hemostasis time[4(3,6)min vs.9(7,15)min],enucleation efficiency[(1.8±0.5)g/min vs.(1.1±0.4)g/min]and hemoglobin decline[13(9,22)g/L vs.17(10,22)g/L]were statistically significant(P＜0.05).In both groups,postoperative IPSS were(6.6±1.7)and(6.2±1.4)respectively,and Qmax were(18.9±3.1)ml/s and(16.8±3.8)ml/s respectively,which were significantly different from that before the operation(P＜0.05).However,there was no significant difference between the two groups(P＞0.05).The enucleation efficiency increased with the increase of prostate volume(r=0.791,0.880 respectively,P＜0.05).After 2 weeks of follow up the postoperative immediate urinary continence rate of UEBT group and LT group were 10.0％(5/50)and 27.3％(15/55),respectively,and the two groups had statistical differences(P＜0.05).But after 3 months of follow up,there was no urinary continence in the two groups,and incidence of postoperative urethral stricture were 2.0％(1/50)and 5.5％(3/55)respectively in UEBT and LT group,whose difference was not significant(P＞0.05).Conclusions ThuLERP can relieve lower urinary tract symptoms in a comparable way with high efficacy and safety.ThuLERP with the"U-shaped"en bloc technique was statistically superior to the lobe technique in operation time,enucleation time,enucleation efficiency,hemoglobin decline and also avoided stress urinary incontinence at early stage after operation.
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