Abstract

Purpose

Patients presenting with prostate gland sizes greater than 200 cc pose a unique surgical challenge to both patients and surgeons. The objective of this study is to critically assess the efficacy and risks associated with performing holmium laser enucleation of the prostate (HoLEP) on glands ≥ 200 cc.

Materials and methods

Using a prospective maintained database, all consecutive benign prostatic hyperplasia (BPH) patients with gland size ≥ 200 cc who underwent HoLEP were included. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Subgroup analysis of outcomes was stratified by gland sizes 200–299 cc and ≥ 300 cc. Univariate analysis using Kruskal–Wallis and Fisher exact test was performed to compare the two groups.

Results

There were 88 patients with a mean preoperative gland size of 255.9 cc (200–770 cc). Mean operative (171 vs 182 min) and enucleation time (77 vs 83 min) were not different between the two subgroups (200–299 cc vs ≥ 300 cc). Enucleation efficiency was greater for glands ≥ 300 cc (2.6 cc/min vs 2.0 cc/min, p = 0.04). Morcellation time was longer in the ≥ 300 cc group (74.5 min vs 46.8 min, p = 0.021). Mean length of stay was 1.8 ± 1.2 days and catheter duration was 2.6 ± 2.7 days. 1 (1.1%) patient required retreatment of BPH at last follow-up. The main limitation of this study is the retrospective data analysis.

Conclusions

Holmium laser enucleation for prostate glands volume > 200 cc is feasible with minimal morbidity. These data further reinforce the size independence success of this procedure for BPH.

中文翻译：

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钬激光前列腺摘除术治疗非常大的良性前列腺增生（≥ 200 cc）

摘要

目的

前列腺大小超过 200 cc 的患者对患者和外科医生都提出了独特的手术挑战。本研究的目的是严格评估与对 ≥ 200 cc 腺体进行钬激光前列腺摘除术 (HoLEP) 相关的疗效和风险。

材料和方法

使用前瞻性维护的数据库，包括所有接受 HoLEP 的腺体大小 ≥ 200 cc 的连续良性前列腺增生 (BPH) 患者。我们报告了患者术前、术中、术后的结果和并发症。结果的亚组分析按腺体大小 200–299 cc 和 ≥ 300 cc 进行分层。使用 Kruskal-Wallis 和 Fisher 精确检验进行单变量分析以比较两组。

结果

有 88 名患者的术前平均腺体大小为 255.9 cc (200-770 cc)。两个亚组（200–299 cc vs ≥ 300 cc）的平均手术时间（171 对 182 分钟）和摘除时间（77 对 83 分钟）没有差异。腺体 ≥ 300 cc 的去核效率更高（2.6 cc/min vs 2.0 cc/min，p  = 0.04）。≥ 300 cc 组的粉碎时间更长（74.5 分钟 vs 46.8 分钟，p  = 0.021）。平均住院时间为 1.8 ± 1.2 天，导管持续时间为 2.6 ± 2.7 天。1 (1.1%) 名患者在最后一次随访时需要再次治疗 BPH。本研究的主要局限性在于回顾性数据分析。

结论

对于体积 > 200 cc 的前列腺，钬激光摘除术是可行的，发病率最低。这些数据进一步加强了 BPH 手术的大小独立性成功。