钬激光前列腺剜除术用于良性前列腺增生的效果分析

目的 探讨将钬激光前列腺剜除术用于良性前列腺增生（BPH）患者的疗效。方法 选择2020年2月至2022年1月在本院接受的BPH患者62例为研究对象,依据采取的不同手术方法将62例BPH患者分成经尿道前列腺钬激光剜除术（HoLEP）组与经尿道前列腺电切术（TURP）组。比较两组患者的围手术期指标、住院时间、术后并发症。结果 与TURP组相比,HoLEP组的手术时间明显延长,按尿管留置时间与住院时间明显缩短,术后血红蛋白下降值显著降低（P<0.01）;术后3个月,HoLEP组与TURP组的最大尿流率（Qmax）、残余尿量（PVR）以及国际前列腺症状评分（IPSS）评分显著下调,但Ho LEP组下调更明显（P<0.01）;HoLEP组术后并发症的发生率显著低于TURP组（P<0.05）。结论 HoLEP与TURP均为BPH的有效治疗手段,但HoLEP可明显缩短手术、尿管留置以及住院的时间,减少术中出血量,以及降低术后并发症。     

经尿道钬激光前列腺剜除术治疗大体积良性前列腺增生

目的：评价经尿道钬激光前列腺剜除术（HoLEP）治疗大体积良性前列腺增生（BPH）的价值。方法：BPH患者60例，前列腺重量均〉100g，分为HoLEP组（n=32）和耻骨上经膀胱前列腺切除术组（n=28）。比较两组手术时间、术中出血量和术后膀胱冲洗时间、导尿管留置时间、住院时间；术后3个月随访，比较两组患者IPSS、生活质量评分（QOL）、最大尿流率（Qmax）、剩余尿量（PVR）等指标的变化。结果：HoLEP组与耻骨上经膀胱前列腺切除术组比较手术时间有所延长（P〈0．01），但术中出血量减少（P〈0．01），膀胱冲洗时间、导尿管留置时间、术后住院时间明显缩短（P〈0．01）。术后3个月，两组IPSS、QOL、Qmax、PVR较自身术前显著改善（P〈0．01），组间比较差异无显著性（P〉0．05）。结论：HoLEP治疗大体积BPH具有与开放性前列腺切除术相似的疗效，同时手术安全性高、患者痛苦小、术后恢复快，是一种更适合于大体积BPH治疗的手术方式。     

经尿道前列腺钬激光剜除术治疗良性前列腺增生的疗效研究

目的：观察经尿道前列腺钬激光剜除术（holmiumlaserenucleationoftheprostate,HoLEP）治疗良性前列腺增生的临床疗效及安全性。方法应用100W钬激光和组织粉碎器对480位良性前列腺增生症的患者行经尿道钬激光前列腺剜除术和组织粉碎术。分别记录患者术前、术中及术后随访的临床资料,分析及评估HoLEP的疗效及安全性。结果480例手术均成功,手术时间25～240min,平均（76．1±39．2）min,切除腺体15～320g,平均（45．8±15．4）g。术后留置导尿48～216h,平均（72．5±23．2）h,术后膀胱持续冲洗时间0～48h,平均（23．6士11．2）h,术后住院时间3～15d,平均（3．36±1．25）d,血红蛋白平均降低（1．1±0．5）g／dL。术后IPSS、QOL、Qmax、PVR较术前明显改善（P〈0．01）。术后并发症率低。结论经尿道前列腺钬激光剜除治疗良性前列腺增生疗效安全可靠,并发症少,剜除彻底,并且适应范围广,有可能挑战TURP成为治疗BPH的新的金标准。     

经尿道钬激光前列腺剜除术治疗大体积良性前列腺增生

目的:评价经尿道钬激光前列腺剜除术(HoLEP)治疗大体积良性前列腺增生(BPH)的价值。方法:BPH患者60例,前列腺重量均>100g,分为HoLEP组(n=32)和耻骨上经膀胱前列腺切除术组(n=28),比较两组手术时间、术中出血量和术后膀胱冲洗时间、导尿管留置时间、住院时间;术后3个月随访,比较两组患者IPSS、生活质量评分(QOL)、最大尿流率(Qmax)、剩余尿量(PVR)等指标的变化。结果:HoLEP组与耻骨上经膀胱前列腺切除术组比较手术时间有所延长(P<0.01),但术中出血量减少(P<0.01),膀胱冲洗时间、导尿管留置时间、术后住院时间明显缩短(P<0.01)。术后3个月,两组IPSS、QOL、Qmax、PVR较自身术前显著改善(P<0.01),组间比较差异无显著性(P>0.05)。结论:HoLEP治疗大体积BPH具有与开放性前列腺切除术相似的疗效,同时手术安全性高、患者痛苦小、术后恢复快,是一种更适合于大体积BPH治疗的手术方式。     

经尿道摩西2.0激光前列腺剜除术治疗良性前列腺增生的疗效

目的：探讨摩西2.0钬激光前列腺剜除术(MoLEP)治疗良性前列腺增生（BPH）的临床效果及安全性。方法：选取上海交通大学医学院附属仁济医院泌尿科2021年3月至6月接受手术治疗BPH患者80例,随机数表法分为MoLEP组38例和常规100W钬激光前列腺剜除术（HoLEP）组42例,比较两组患者围手术期指标、术后1月和6月排尿参数国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、排尿后残余尿量（PVR）和并发症情况。结果：MoLEP组相比HoLEP组止血时间[（6.6±1.1）vs.(11.2±2.3)min]、术中[（27.5±7.3）vs.(44.2±9.8)×103ml]及术后[（20.5±5.6）vs.(35.8±10.2)×103ml]膀胱冲洗量减少,差异具有统计学意义（P<0.05）。两组患者术后1月和6月IPSS、Qmax和PVR差异无统计学意义（P>0.05）。术后1月MoLEP组1例出现压力性尿失禁,HoLEP组2例出现压力性尿失禁,随访至术后6月尿失禁症状均能完全缓解。结论：摩西2.0激光前列腺剜除术治疗BPH有良好的止血效果及较高的手术效率,术后...     

经尿道钬激光前列腺剜除术治疗良性前列腺增生

目的 :评价经尿道钬激光前列腺剜除和前列腺组织粉碎术治疗良性前列腺增生 (BPH)的临床效果。　方法 :应用 10 0W钬激光器和组织粉碎器对 35例BPH病人实施经尿道钬激光剜除和前列腺组织粉碎术治疗。　结果 :本组 35例手术均获成功。手术时间 30～ 180min ,平均 (6 0 .0± 2 3.2 )min。获得前列腺组织 10～ 5 6g ,平均(31± 9) g ,术后留置导尿管时间 2 0h～ 4d ,平均1.5d。无术中术后输血病例。组织病理学诊断均为BPH。 32例获随访 ,术后 3个月随访国际前列腺症状评分 (IPSS)由 (2 4.0± 6 .2 )分降至 (5 .6± 3.6 )分 (P <0 .0 0 1)。最大尿流率 (Qmax)由 (8.5± 3.9)ml/s上升至 (2 2 .0± 7.2 )ml/s(P <0 .0 0 1) ,残余尿由 (138± 12 5 )ml减少到 (2 1± 15 )ml,未发生严重并发症。　结论 :钬激光前列腺剜除术是治疗BPH的有效微创方法 ,术中术后出血少 ,能够完整剜除增生的前列腺组织。留置导尿管时间短 ,临床症状改善明显。     

经尿道钬激光前列腺剜除术与前列腺电切术近期疗效的对比分析

目的比较前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)和前列腺电切术(transurethral resection of the prostate,TURP)治疗良性前列腺增生(benign prostatic hyplasia,BPH)的疗效及安全性。方法将2012年6月至2013年7月90例行腔内手术治疗的BPH患者随机分为2组,分别行前列腺钬激光剜除术(HoLEP)和经尿道前列腺电切术(TURP)。监测、记录2组患者围手术期和术后1、3、6个月复查指标,比较最大尿流率(maximum flow rate,Qmax)、国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(quality of life score,QOL)等变化并进行统计学分析,比较两种术式近期临床疗效。结果术前两组患者一般情况和国际前列腺症状评分、生活质量评分、最大尿流率、残余尿量测量以及前列腺重量比较差异无统计学意义(P0.05);HoLEP组较TURP组术中出血量、手术时间、低钠血症的发生率、膀胱冲洗时间、留管时间都较低(P0.01);术后1个月、3个月及6个月2组IPSS、QOL和Qmax均比术前有明显改善(P0.01);但2组间比较并无显著统计学意义(P0.05)。结论 HoLEP术与TURP术相比,近期手术效果相似,且手术安全性更好,可视为治疗BPH的较好新方法。     

等离子电切术与钬激光剜除术治疗体积>80ml前列腺增生的比较

目的 比较经尿道前列腺等离子双极电切术（TUPKP）与经尿道前列腺钬激光剜除术（HoLEP）治疗体积>80 ml前列腺增生（BPH）的安全性及疗效。方法 纳入佛山复星禅诚医院泌尿外科2017年1月至2021年1月收治的80例前列腺体积>80 ml的前列腺增生患者,按随机数字法将其分为TUPKP组、HoLEP组,剔除失访病例,两组顺利完成研究的分别有37例、35例,记录两组术前及术后IPSS、QOL、Qmax、RUV、手术时间、术中出血量、术后留置尿管时间、术后住院天数、并发症等。结果 两组均能一期完成手术,HoLEP组的手术时间、术后留置尿管天数、术后住院天数均明显少于TUPKP组（P<0.05）,两组术后膀胱冲洗时间差异无统计学意义（P>0.05）;HoLEP组切除的前列腺组织量多于TUPKP组（P<0.05）,但手术出血量少于后者（P<0.05）。两组术后1个月、6个月的IPSS、RUV、QOL较术前显著降低（P<0.05）,Qmax较术前明显增高（P<0.05）;TUPKP组术后1个月的IPSS及QOL改善比HoLEP组更为明显（P...     

钬激光前列腺剜除术与前列腺汽化电切术治疗良性前列腺增生的疗效比较

目的 比较经尿道前列腺汽化电切术与经尿道钬激光前列腺剜除术治疗前列腺增生症 的疗效。 方法 将160例前列腺增生症( benign prostatic hyperplasia,BPH)患者随机分为两组,每组80例,分别用 TUVP 及HoLEP 治疗 。比较两种术式 的手术时间、手术出血量、 膀胱冲洗时间 、住院时间、并发症及近期疗效等指标 。结果 两组患者术后国际前列腺症状评分 （IPSS）、生活质量评分（ QOL）、最大尿流率和残余尿量均较术前明显改善,但两组上述指标间比较差异无显著性差异 。HoLEP组术中出血量、术后膀胱冲洗时间、住院时间明显短于TUVP组;并发症发 生率低于TUVP组。 结论 TUVP 及HoLEP 治疗前列腺增生症均有效;HoLEP的手术安全性优于TUVP。     

经尿道摩西钬激光前列腺剜除术治疗良性前列腺增生的临床研究

目的探讨经尿道摩西钬激光前列腺剜除术在良性前列腺增生(BPH)患者中的应用效果,旨在为BPH患者快速康复提供更好的手术治疗方案。方法应用前瞻性随机双盲对照研究法,选取2018年8月至2019年11月在本院住院的80例BPH患者作为研究对象,将其随机分为两组,对照组(40例)采用经尿道100 W钬激光前列腺剜除术,研究组(40例)采用经尿道摩西钬激光前列腺剜除术,手术均由同一医师完成,术式为改良钬激光前列腺剜除术(三叶十七步法);比较两组的前列腺剜除时间、术中出血量、术后3 h血清钠下降程度、术后拔除尿管时间、住院时间,统计两组患者术前、术后3个月的最大尿流率(Qmax)、残余尿量(PVR)、国际前列腺症状评分(IPSS),观察学习曲线等指标。结果研究组的前列腺剜除时间、术中出血量、术后拔除尿管时间、住院时间比较差异有统计学意义(P<0.05),两组患者手术前后的血清钠变化差异无统计学意义(P>0.05);两组术后3个月的Qmax、PVR、IPSS均较治疗前显著改善(P<0.05),但术后组间比较差异无统计学意义(P>0.05);两组患者术中均无膀胱损伤及TUR综合征患者,无输血患者,无术后尿道外口狭窄患者,术后均无严重并发症;学习曲线方面,经尿道摩西钬激光前列腺剜除术的学习曲线较短。结论经尿道摩西钬激光前列腺剜除术安全性高、风险较小、疗效良好、术后康复快,且学习曲线较短,表现出较高的临床应用价值。     

Holmium laser enucleation of the prostate (HoLEP) in patients with continuous oral anticoagulation: first reported cases in Japan

Oral anticoagulation (OA) has been considered as a strict contraindication to transurethral resection of the prostate (TURP). In recent years, some studies have shown that holmium laser enucleation of the prostate (HoLEP) has less blood loss compared to TURP. Thus we have performed HoLEP in patients with benign prostatic hyperplasia (BPH) under continuous OA from September 2009, and herein we report our first nine cases. Patients received HoLEP by a single surgeon at our institution. HoLEP was performed successfully in all patients. The mean times to complete enucleation and morcellation were 48.2 and 5.1 minutes, respectively. The mean tissue weight of enucleation was 37 grams. The mean hemoglobin and sodium loss after HoLEP were 1.7 g/dl and 1.3 mEq/L, respectively, and the catheterization time was 1.6 days. Blood transfusion, clot retention or transurethral resection syndrome were not observed in any cases. HoLEP has excellent hemostatic properties, and is a safe and effective procedure for patients with symptomatic BPH under the condition of continuous OA.     

Holmium laser enucleation for large (greater than 100 mL) prostate glands

BACKGROUND: To evaluate the holmium laser enucleation of the prostate (HoLEP) using the transurethral soft tissue morcellator (TUSTM), as a primary surgical treatment for symptomatic benign prostatic hyperplasia (BPH) with prostate glands > 100 mL. METHODS: Eighteen patients with preoperative prostate volumes > 100 mL underwent the HoLEP procedure. The criteria for surgery were determined by a preoperative International Prostate Symptom Score (IPSS), a prior failure of medical therapy, and urinary retention. RESULTS: The mean preoperative IPSS and prostate gland size were 13.8 and 142.3 mL, respectively. The total energy used by the laser was 288.4 kJ. The mean catheter time was 23.8 h and, perioperatively, no patients had electrolyte abnormalities or required blood transfusions. The 3-week postoperative IPSS was 2.8, with minimum long-term complications. CONCLUSIONS: Holmium laser enucleation of the prostate with TUSTM is a safe and effective alternative to open prostatic surgery for glands > 100 mL.     

Simultaneous holmium laser enucleation of prostate and upper-tract endourologic stone procedures

BACKGROUND AND PURPOSE: The holmium laser is a versatile urologic tool. Its unique cutting and coagulating properties allow multiple procedures, such as stone fragmentation and laser enucleation of the prostate (HoLEP), to be performed with a single set-up. This paper reviews our experience with simultaneous HoLEP and endourologic upper-tract stone procedures. PATIENTS AND METHODS: We retrospectively reviewed all 11 patients (12 renal units) treated with the combined approach of HoLEP and an upper-tract endourologic procedure for stone disease. All patients initially underwent HoLEP, followed immediately by percutaneous nephrolithotomy (PCNL)(N=2), ureteroscopy (URS)(N=8), or both (N=1). The mean stone diameter was 34.7 mm for PCNL and 6.7 mm for URS. Outcome data and complications were recorded. RESULTS: The mean preoperative and postoperative American Urological Association Symptom Scores were 21.8 and 6.3, respectively. The mean prostatic specimen weight was 118 g (range 21-376 g), and the mean hospital stay was 1.4 days. For 10 patients with available prostatic specific antigen (PSA) data, the mean preoperative and postoperative values were 6.2 and 0.9 ng/mL, respectively. All patients were catheter free at discharge. All three PCNL patients were rendered stone free; all four URS patients who had radiographic follow-up were stone free. There were no short- or long-term complications, and no transfusions were necessary. CONCLUSIONS: Simultaneous HoLEP and laser lithotripsy are feasible, emphasizing the unique capabilities of the holmium laser. The hemostasis offered by HoLEP allows safe removal of prostatic tissue and urinary calculi, obviating multiple procedures.     

Sequential holmium laser enucleation of the prostate and laparoscopic extraperitoneal bladder diverticulectomy: initial experience and review of literature

BACKGROUND AND PURPOSE: Urologic applications of laparoscopy and the holmium laser have increased exponentially in the past few years. We present our experience with sequential holmium laser enucleation of the prostate (HoLEP) and extraperitoneal laparoscopic diverticulectomy for a large symptomatic bladder diverticulum and associated bladder outlet obstruction. PATIENTS AND METHOD: From June 2004 to June 2005, three patients with benign prostatic hyperplasia (BPH) and a large secondary bladder diverticulum were offered sequential HoLEP and laparoscopic extraperitoneal bladder diverticulectomy. Demographic data and perioperative outcomes were recorded. A review of the literature was performed to determine the present role of laparoscopic diverticulectomy. RESULTS: All patients underwent the planned procedure successfully. The mean operating time was 63.33 minutes for HoLEP and 246.6 minutes for diverticulectomy. Oral intake was resumed after a mean of 8.6 hours. The mean postoperative analgesia required was 146 mg of parecoxib sodium, and the mean drop in hemoglobin was 1.13 g/dL. Patients were discharged after an average of 66.6 hours. At 1-month follow-up, the average American Urological Association Score had improved from 13 to 6, the post-void [corrected] residual urine volume had decreased from 997 mL to 164 mL, and the peak uroflow rate had improved from 4.9 mL/sec to 10.4 mL/sec. These measures showed further improvement on later follow-up. A total of 30 cases of laparoscopic diverticulectomy have been reported in literature [corrected] of which only two were done extraperitoneally. CONCLUSION: Simultaneous HoLEP and laparoscopic extraperitoneal diverticulectomy is an effective strategy for the treatment of BPH with associated large bladder diverticulum.     

Laser prostatic surgery: An update

This review presents an overview of the current state of the art of laser prostatic surgery. Several types of lasers have been used in the treatment of benign prostatic hyperplasia (BPH) over the past 15 years. Vaporization techniques have recently gained popularity and have been widely accepted by many urologists. Short-term results show that vaporization of a prostatic adenoma with higher-power potassium titanyl phosphate and holmium lasers is safe and effective in the treatment of symptomatic BPH. However, well designed randomized comparative trials with long-term follow-up are still needed. Holmium laser is a multi-purpose surgical tool and has multiple applications in urology. In the treatment of symptomatic BPH, holmium laser can be used in ablation, resection and enucleation of the prostate. Holmium laser enucleation of the prostate (HoLEP) is the most investigated laser procedure used in the treatment of symptomatic BPH. Several randomized controlled trails confirmed the safety, efficacy, and durability of HoLEP regardless of the prostate size.     

Holmium laser enucleation of the prostate: the Kobe City General Hospital experience

Between October 2004 and August 2005, 43 patients with the mean age of 70.9 (ranging 57-83) years, who had lower urinary tract symptoms underwent holmium laser enucleation of the prostate (HoLEP) at our hospital. The mean operative time, change in hemoglobin and resected tissue weight were 193 (83-390) minutes, -2.1 (-5.3 -/+ 1.3) g/dl and 40.2 (6.3-90.9) g, respectively. The mean postoperative urethral catheter time and postoperative hospital stay were 1.7 and 5.5 days, respectively. Minor prostatic capsular perforation and bladder mucosal injuries in 18 cases without need of additional interventions or treatments. Blood transfusion for preoperative anemia was needed in one case. Postoperatively, high fever occurred in 6 cases including sepsis in one case, while recatheterization was needed in 2 cases because of urination difficulty. After discharge, meatal stenosis was found in 7 cases, urethral stenosis in 3 cases including 2 cases with preoperative urethral stenosis. Scrotal abscess developed after acute epididymitis in one case. Transient urinary incontinence reported in 12 cases, which requires medication or more than 1 pad per day. HoLEP improved international prostate symptom score, quality of life score, peak urinary flow rates and postvoiding residual urine volumes immediately and significantly. HoLEP is a feasible and effective procedure to relieve lower urinary tract symptoms, although technical and instrumental advances are required to reduce the operative time and complications.     

Enucleation of the prostate: An anatomical perspective

Among transurethral surgery for benign prostatic hyperplasia (BPH), anatomical endoscopic enucleation of the prostate (AEEP) differs from conventional transurethral surgery as it adopts the same enucleation principle as open surgery. AEEP is known as an effective and safe surgical method. However, the learning curve is steep because the surgical anatomy is different from that of conventional transurethral surgery. If information on surgical anatomy related to enucleation is enriched and surgical standardisation is achieved, the learning curve will be shortened and AEEP will become more widespread. The concept of AEEP has been developed based on the surgical techniques obtained from holmium laser enucleation of prostate (HoLEP). The original surgical technique of HoLEP is a three-lobe technique. At the 12 o'clock position at the prostatic apex, the boundary of the prostate capsule is unclear. Separating anterior prostatic tissue from the prostatic capsule while preserving the sphincter in the apical area is one of the biggest challenges in AEEP. During the AEEP procedure, an accurate understanding of the surgical anatomy of the capsular plane, bladder neck, apical sphincteric area and blood vessels is important. In this article, literature on the anatomy related to enucleation in AEEP, mainly HoLEP, is reviewed and discussed.     

四种经尿道前列腺剜除术的疗效和安全性比较

目的比较不同手术治疗良性前列腺增生症(BPH)的有效性和安全性。方法回顾性分析2018年1月至2019年7月入住空军军医大学唐都医院的277例手术治疗的BPH患者的临床资料。其中第二代半导体红激光前列腺剜除(DiLEP)手术组88例,钬激光前列腺剜除(HoLEP)手术组50例,经尿道前列腺等离子双极电切剜除术(PKEP)手术组85例,铥激光前列腺剜除(THuVEP)手术组54例,比较4组手术病例手术时间、术后血红蛋白下降值、术后最大尿流率(Qmax)改善值、术后并发症、手术后国际前列腺症状评分(IPSS)改善等参数,分析4种手术方法的疗效与安全性。结果手术均获成功,HoLEP、DiLEP、PKEP、THuVEP4组患者年龄分别为(68.84±6.28)、(70.94±6.14)、(70.31±7.33)、(70.37±5.87)岁,前列腺体积分别为(61.85±16.51)、(61.23±17.37)、(58.40±17.04)、(63.82±19.68)mL,差异均无显著性统计学意义(P>0.05);而手术时间[(94.24±39.13)、(93.67±50.31)、(117.25±62.99)、(97.46±40.62)min]、血红蛋白下降值[(8.40±5.18)、(9.80±5.22)、(11.89±8.18)、(10.48±4.39)g/L]、IPSS评分改善值[(13.14±5.43)、(13.42±3.93)、(11.38±4.55)、(12.20±4.56)分]以及最大尿流率(Qmax)改善值[(17.42±4.87)、(14.89±2.69)、(14.58±4.76)、(15.17±3.08)mL/s],4项指标差异均有显著性统计学意义(P<0.05)。结论与PKEP相比,HoLEP与DiLEP手术时间短、术中止血效果好、术后前列腺症状改善明显;THuVEP手术时间短;DiLEP尿失禁发生率较低,具有良好的安全性。