经尿道大功率钬激光前列腺剜除术(HoEAP)

目的　经尿道前列腺钬激光剜除、前列腺组织粉碎术的疗效评价。　方法　自 2 0 0 1年 8月起应用 10 0W钬激光器以及组织粉碎器对 82例前列腺增生进行经尿道前列腺的钬激光剜除与前列腺组织粉碎。　结果全部病例手术顺利 ,手术切除时间 :(2 5～ 68)分钟 ,被切下的前列腺组织 (2 5～ 76)克。平均 5 9.5克 ,组织粉碎时间 :(2 0～ 90 )分钟 ,术后留置尿管 16小时～ 96小时 ,平均 3 6小时 ,拔管即恢复排尿。随防 2月～ 2 8月 ,平均 5月 ,I-PSS评分达优 5 4例(65 .8% )、良 16例 (19.5 % )、中 12例 (14 .6% )。无严重并发症。　结论　钬激光剜除前列腺技术 ,切割精确 ,安全快捷 ,出血少 ,组织粉碎技术可靠 ,速度快 ,术后患者排尿畅通     

比较经尿道前列腺汽化电切术与经尿道前列腺钬激光剜除术治疗良性前列腺增生症的效果

目的比较经尿道前列腺汽化电切术与经尿道前列腺钬激光剜除术治疗良性前列腺增生(BPH)的效果。方法将45例BPH患者根据手术方式分为2组,汽化组(22例)给予经尿道前列腺汽化电切术,钬激光组(23例)实施经尿道前列腺钬激光剜除术。比较2组手术时间、术中出血量、膀胱冲洗时间、留置尿管时间及并发症发生情况。结果钬激光组术中出血量、膀胱冲洗时间、留置尿管时间均低于汽化组;术后排尿困难、出血、尿道狭窄并发症发生率低于汽化组。差异均有统计学意义(P0.05)。结论经尿道钬激光剜除术治疗BPH,创伤小、并发症发生率低、患者术后康复快。     

经尿道前列腺钬激光剜除术与前列腺电切术治疗良性前列腺增生效果比较

目的比较经尿道前列腺钬激光剜除术与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的效果。方法随机将58例BPH患者分为2组,各29例。对照组行TURP,观察组行经尿道前列腺钬激光剜除术。结果观察组手术时间、术中出血量及术后留置尿管时间、住院时间均少于或短于对照组,差异有统计学意义(P0.05)。2组术后3个月IPSS评分均较术前显著改善,差异有统计学意义(P0.05),但组间无显著性差异(P0.05)。结论经尿道前列腺钬激光剜除术与TURP均能有效改善BPH患者的临床症状,但前者术中出血量少,尿管留置时间短,更利于促进患者早期恢复。     

经尿道电气化术联合电切术治疗前列腺增生症(附122例报告)

目的 :探讨良性前列腺增生症 (BPH)的有效治疗方法。方法 :联合应用经尿道前列腺电气化术(TUVP)和经尿道前列腺电切术 (TURP)治疗BPH患者 12 2例 ,平均年龄 72 .3岁 ,其中Ⅰ度增生 8例 ,Ⅱ度增生5 1例 ,Ⅲ度增生 37例 ,Ⅳ度增生 2 6例。结果 :手术操作时间 30～ 15 0min ,平均 74.2 9min。 1例 (0 .8% )术中输血40 0ml,2例 (1.6 % )术后输血 2 0 0～ 40 0ml。发生 1例 (0 .8% )电切综合征。术后平均留置导尿管 5d。随访 1～10个月 ,国际前列腺症状评分 (IPSS)由术前 (2 9.8± 1.5 )分降至术后 2个月 (10 .9± 1.0 )分 (P <0 .0 1) ,排尿通畅 ,并发症少。结论 :TUVP与TURP联合应用治疗BPH具有二者的优点 ,出血少 ,能切除更多前列腺组织 ,并发症少 ,疗效显著     

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。     

经尿道电切术治疗重度前列腺增生症

目的 :探讨重度前列腺增生症经尿道电切治疗效果。方法 :采用经尿道前列腺电切术 (TURP)治疗重度 BPH 70例 ,随访 3～ 18个月。结果 :切除前列腺重量平均 74.6 g,平均手术时间 70 min。术后平均留置导尿管 3 d,术后平均住院时间 5 d。最大尿流率 (Qmax)由术前的 (6 .3± 1.5 ) ml/ s上升至术后 3个月的 (15 .1± 4.7)m l/ s,前列腺症状评分 (IPSS)术前为 (2 9.7± 1.2 )分 ,术后 3个月降至 (5 .1± 1.0 )分 (P<0 .0 1)。结论 :TURP安全、并发症少、疗效好。重度 BPH不是 TU RP的禁忌证。     

钬激光前列腺剜除术与电切术安全性及疗效比较

目的 比较并探讨钬激光前列腺剜除术(HoLEP)和传统经尿道前列腺电切术(TURP)的安全性及疗效,旨在为良性前列腺增生症的临床治疗提供理论依据.方法 回顾性分析哈尔滨医科大学附属第四医院2015年1月-2016年1月收治的349例良性前列腺增生症患者的病例资料,并将其随机分成两组.其中172例患者选择行钬激光前列腺剜除术,另外177例患者选择行传统经尿道前列腺电切术.比较两组患者术中出血量、手术时间、术后导尿管留置时间、术后住院天数以及术后并发症(尿失禁、膀胱痉挛、出血)的发病率.随访3个月,重新评估IPSS、QOL、Qmax指标并比较疗效.结果 与传统经尿道前列腺电切术组相比,钬激光前列腺剜除术组患者的手术时间明显缩短、术中出血量及术后住院天数显著降低(P＜0.05),术后导尿管留置时间[钬激光前列腺剜除术组:(2.4±0.5)d;传统经尿道前列腺电切术组:(5.7±0.6)d,P＜0.05].明显减少,术中切除前列腺重量明显增加,术后并发症的发病率[钬激光前列腺剜除术组:5/172(2.9％);传统经尿道前列腺电切术组:19/177(10.7％),P＜0.01]显著下降.3个月后,两组术后PVR、IPSS、QOL以及Qmax较术前相比明显改善(P＜0.01),组间比较差异无统计学意义(P＞0.05).结论 钬激光前列腺剜除术与传统经尿道前列腺电切术相比疗效相当,但安全性更高.钬激光前列腺剜除术治疗临床前列腺增生症具有重要意义.     

钬激光和铥激光在经尿道前列腺剜除术中应用的对比性研究

目的:研究、比较钬激光和铥激光在经尿道前列腺剜除术中的有效性和安全性。方法:将98例BPH患者分为两组,分别采用钬激光(Ho组)或铥激光(Th组)经尿道前列腺剜除术,比较两组患者手术前后IPSS评分、残余尿量、最大尿流率、手术失血量及电解质等指标变化。结果:两组患者年龄、前列腺体积、术前IPSS评分、残余尿量及最大尿流率等指标均无统计学差异(P均>0.05)。Th组手术时间67～145min,平均(84.6±10.2)min,出血量50～240ml,平均(126.5±14.6)ml。术后平均留置尿管时间2.4d。Ho组手术时间46～122min,平均(70.5±7.5)min,术中失血量80～400ml,平均(176.5±14.1)ml,无输血事件。术后平均尿管留置时间2.5d。Ho组手术时间较Th组短(P=0.032),而失血量似大于Th组,但并无统计学差异(P=0.071)。两组患者手术前后血红蛋白、血Na+、渗透压等均无明显差异,无电切综合征者。两组术前IPSS、残余尿、最大尿流率与术后第3个月指标相比,均存在统计学差异(P均<0.05)。各指标同期对比均无统计学差异(P>0.05)。结论:钬激光或铥激光经尿道前列腺剜除术均可有效缓解下尿路梗阻症状(LUTS),其短期效果相当。术中铥激光止血效果确切,但解剖清晰度逊于钬激光。     

前列腺钬激光剜出术与电切术安全性及疗效比较

目的比较研究经尿道钬激光前列腺剜除术(HoLEP)与经尿道前列腺电切术(TURP)的安全性及疗效.方法337例良性前列腺增生(BPH)患者分为2组,185例行HoLEP术,152例行TURP术;测定术中冲洗液吸收量、出血量;比较2组术中冲洗液吸收量、出血量、前列腺切除重量、手术时间、导尿管留置时间、术后住院天数、手术并发症.随访3个月,比较2组最大尿流率(Qmax)、剩余尿量(PVR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等指标的变化.结果HoLEP组、TURP组术中冲洗液吸收量、出血量、前列腺切除重量、手术时间、导尿管留置时间、术后住院天数分别为(604.8±97.6)ml及(1095.0±209.8)ml、(124.3±24.1)ml及(330.3±36.9)ml、(17.4±2.2)g及(25.2±3.4)g、(54.9±20.0)min及(45.1±18.0)min、(2.2±0.2)d及(3.4±0.3)d、(5.2±1.1)d及(8.8±1.3)d,组间比较差异有显著性意义(P＜0.05).HoLEP组术中1.6%(3/185)需输血;TURP组11.8%(18/152)需输血.HoLEP组术后需要膀胱持续冲洗者占6.5%(12/185),TURP组占95.4%(145/152).TURP组有55.3%(84/152)出现术后低血钠,其中5.3%(8/152)发生严重的低钠血症;HoLEP组无低钠血症发生,但有4例使用Morcellator粉碎前列腺组织时损伤膀胱黏膜致出血者.组织病理检查结果HoLEP组均为良性前列腺增生;TURP组有6例前列腺偶发癌、5例前列腺上皮内瘤(PIN).术后3个月152例HoLEP患者和106例TURP患者获随访,Qmax,PVR,IPSS,QOL较术前均有改善,差异有显著性意义(P＜0.01);组间比较差异无显著性意义(P＞0.05).结论HoLEP术与TURP术相比,手术安全性更好,疗效相似;组织标本获得率的下降可能影响前列腺偶发癌的检出率.     

经尿道钬激光前列腺剜除术治疗前列腺增生

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,探讨手术操作技巧及并发症的预防。方法应用100 W钬激光器和组织粉碎器对45例BPH患者实施经尿道钬激光前列腺剜除（HoLEP）和组织粉碎术。术前国际前列腺症状评分（IPSS）为15-32分,平均24.0分,最大尿流率（Qmax）为4-15 mL/s,平均8.4 mL/s,膀胱残余尿为60-246 mL,平均115 mL。结果41例行HoLEP手术成功。手术时间50-200 min,平均105 min,获得前列腺组织30-85 g,平均48.6 g,其中输血5例,膀胱黏膜或膀胱壁损伤5例,尿失禁1例,尿道狭窄3例。保留导尿时间3-7 d,平均4.3 d。术后35例获随访3个月,IPSS降至3-10分,平均5.2分（P〈0.01）,Qmax升至18-25 mL/s,平均22.4 mL/s（P〈0.01）,膀胱残余尿为0-68 mL,平均26 mL（P〈0.01）。结论经尿道钬激光剜除前列腺组织损伤小,术中出血少,并发症少,疗效可靠。HoLEP学习曲线较长,应注意手术技巧的掌握,减少并发症的发生。     

Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients

PURPOSE: Transurethral electrocautery resection (TURP) is generally regarded as the gold standard surgical treatment for bladder outflow obstruction due to benign prostatic hyperplasia despite its rather high morbidity. The high powered holmium:YAG laser can be used endoscopically to enucleate obstructing prostatic tissue in a relatively bloodless manner. The technique of transurethral holmium laser enucleation of the prostate (HoLEP) was compared to standard TURP for the surgical management of prostate adenomas in a randomized, prospective clinical trial. MATERIALS AND METHODS: A total of 200 urodynamically obstructed patients with a prostate of less than 100 gm on transrectal ultrasound were randomized to HoLEP or TURP. All patients were assessed preoperatively, and 1, 6 and 12 months postoperatively. Patient baseline characteristics, perioperative data and postoperative outcome were compared. All complications were noted. RESULTS: HoLEP was significantly superior to TURP in terms of catheter time, hospital stay and hemoglobin loss but operative time was longer. HoLEP and TURP resulted in a significant improvement in American Urological Association symptom scores, peak urinary flow rates and post-void residual urine volumes with symptoms scores and residual volume significantly better in the holmium group. Effects on continence and potency were similar in the 2 groups but adverse events were less frequent in the holmium group. CONCLUSIONS: HoLEP and TURP are highly effective procedures for removing obstructing prostatic adenomas. HoLEP resulted in significantly better micturition parameters and less perioperative morbidity.     

Comparison of clinical results between TUR-P and holmium laser enucleation of the prostate (HoLEP) based on the initial experience

OBJECTIVE: We compared the surgical results between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TUR-P) for the treatment of men with benign prostatic hyperplasia (BPH). METHODS: A total of 87 patients with symptomatic BPH were analysed. HoLEP was performed on 46 men (mean age 68.2 +/- 7.5 years old) from December 2005 to February 2007, and TUR-P was performed on 41 men (mean age 69.2 +/- 7.3 years old) from April 2004 to March 2006. RESULTS: Both groups were comparable in terms of age, pre-operative IPSS, QOL index, urodynamic study results and prostate volume. During operation, decrease in hemoglobin was less in the HoLEP group than in the TUR-P group (1.15 +/- 1.2 vs 1.91 +/- 1.3 g/dl p < 0.05). The operation time was significantly longer in the HoLEP group than in the TUR-P group (161.9 +/- 65.0 vs. 118.3 +/- 36.9 minutes p < 0.001). Mean resected weight was 29.3 +/- 13.3 g (10-55) in the TUR-P group and 34.8 +/- 33.4 g (5-148) in the HoLEP group (p = 0.337). The catheterization period (52.1 +/- 29.6 vs. 115.2 +/- 27.5 hour p < 0.001) and hospital stay (6.6 +/- 2.3 vs. 9.4 +/- 2.2 days p < 0.001) were significantly shorter in the HoLEP group than in the TUR-P group. At follow up, Qmax, average flow rate and post void residual urine (PVR) in two groups improved significantly, and these parameters were not significantly different between the groups after 3 months. CONCLUSIONS: Both TUR-P and HoLEP were effective in relieving BOO. The estimated blood loss, a catheterization time and hospitalization were less or shorter in the HoLEP group. HoLEP may be a good alternative to the conventional transurethral electrocautery resection of the prostate for symptomatic BPH.     

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.     

影响钬激光前列腺剜除术中出血的多因素分析

目的:评价经尿道钬激光前列腺剜除术(HoLEP)术中出血量的情况,探讨影响出血量的相关因素.方法:回顾性分析299例良性前列腺增生(BPH)患者的临床资料,其中268例行HoLEP,31例行经尿道前列腺电切术(TURP).在手术前和术后第1天晨测量血红蛋白和红细胞比容,并记录术后的输血情况.分析年龄、糖尿病、高血压病、...     

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.     

Laser treatment of benign prostatic hyperplasia

To evaluate the role of lasers that allow acute removal of obstructing tissue in the surgical treatment of benign prostatic hyperplasia (BPH). A MEDLINE search over the last 6 years focused on randomized trials, large case series and review articles. A total of more than 4,000 patients were analyzed with respect to the morbidity and outcome, and the advantages and disadvantages of the various lasers. Laser treatment of BPH has evolved from coagulation to enucleation. Blood loss is significantly reduced as compared to transurethral resection and open prostatectomy. Ablative/vaporizing techniques have recently become popular again with the marketing of new high-powered 80 W potassium-titanyl-phosphate (KTP) and 100 W holmium lasers. Vaporization immediately removes obstructing tissue, but tissue specimen cannot be obtained. KTP short-term results are promising, but long-term results and randomized trials are lacking. Postoperative volume reduction is less than with holmium laser enucleation of the prostate (HoLEP), and the KTP laser can be used for BPH treatment only. HoLEP allows whole lobes of the prostate to be removed. Prostates of all sizes can be operated on. It is at least as safe and effective as TURP and open prostatectomy, with significantly lower morbidity, as shown by several well-designed randomized clinical trials. It provides specimen for histological evaluation. In addition, the holmium laser can be used for the endourological treatment of stones, strictures and tumors. HoLEP appears to be a size-independent new “gold standard” in the surgical treatment of BPH.     

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.