Comparison of three Holmium laser enucleation of the prostate with postoperative urinary incontinence
10.3760/cma.j.cn112330-20240117-00025
- VernacularTitle:三种钬激光前列腺剜除术后尿失禁的比较
- Author:
Peng SUN
1
;
Min XU
1
;
Haixiao WU
1
;
Ting HUANG
1
;
Heng ZHANG
1
;
Li ZHU
1
Author Information
1. 浙江大学医学院附属金华医院泌尿外科，金华 321000
- Publication Type:Journal Article
- Keywords:
Prostatic hyperplasia;
Holmium laser enucleation of the prostate;
Urinary incontinence;
Efficacy
- From:
Chinese Journal of Urology
2024;45(11):831-836
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical efficacy and advantage of urinary continence after holmium laser enucleation of the prostate (HoLEP)with reservation of different structures for benign prostatic hyperplasia (BPH).Methods:The data of 242 patients with BPH who underwent HoLEP in Affiliated Jinhua Hospital Zhejiang University School of Medicine from June 2020 to June 2023 were analyzed retrospectively.Of the 242 patients, 89 received anterior lobe-sparing HoLEP(Group A), 81 received HoLEP with partial urethral mucosa reservation(group B), and 72 received conventional HoLEP(group C). There were no significant differences among the three groups( P > 0.05)in terms of the age[(73.72±6.35)years old vs.(72.58±6.14)years old vs.(73.18±6.73)years old], prostate volume[(82.31±43.58)ml vs.(81.54±42.83)ml vs.(82.12±44.27)ml], the proportion of diabetes mellitus[11 cases(12.4%)vs. 9 cases(11.1%)vs. 7 cases(9.7%)], the proportion of calculus of bladder[9 cases(10.1%) vs. 6 cases(7.4%)vs. 6 cases(8.3%)], the proportion of urinary retention[20 cases(22.5%)vs.17 cases(21.0%)vs. 14 cases(19.4%)], international prostate symptom score(IPSS)[(22.47±3.56) vs.(21.83±4.18)vs.(21.54±3.37)], quality of life score (QOL)[(4.87±0.92) vs.(4.65±0.86) vs.(4.74±0.73)]and quantity of maximum flow rate(Q max)[(8.32±3.09)ml/s vs.(8.41±2.75)ml/s vs.(7.96±2.82)ml/s].The perioperative related indexes of the three groups were compared. IPSS, QOL, Q max, and the incidence of urinary incontinence at 1 week, 1 month and 3 months after surgery were compared in the three groups. Results:All procedures were performed successfully without conversion.Among groups A, B, and C, the differences of surgical enucleation time [(35.17±12.38)min vs. (34.19±10.26)min vs. (33.75±11.34)min], prostate enucleation mass [(57.43±37.58)g vs. (59.72±38.35)g vs. (60.37±39.52)g], retention of urinary catheter time [(3.18±1.55)d vs. (3.62±1.78)d vs. (3.49±1.69)d], the proportion of perforation of the peritoneum [1 case(1.1%) vs. 1 case(1.2%) vs. 2 cases (2.8%)], and the proportion of postoperative infections [1 case (1.1%) vs. 1 case (1.2%) vs. 2 cases (2.8%)]were not statistically significant ( P>0.05). At 1st week and 1st month after surgery in group A, IPSS[(9.41±2.21), (8.34±1.67) points], QOL[(2.17±0.58), (1.89±0.41)points], Q max[(20.53±5.18), (22.41±6.17)ml/s]were significantly improved as compared with those before surgery( P<0.05).At 1st week and 1st month after surgery in group B, IPSS[(10.19±2.47), (8.73±1.81) points], QOL[(2.63±0.62), (2.14±0.57)points], Q max[(19.64±4.59), (21.43±5.39)ml/s]were significantly improved as compared with those before surgery( P<0.05).At 1st week and 1st month after surgery in group C, IPSS[(10.35±1.98), (9.21±1.78)points], QOL[(2.79±0.76), (2.28±0.68)points], Q max[(20.21±5.83), (23.15±5.49)ml/s]were significantly improved as compared with those before surgery( P<0.05).There were no significant differences in the IPSS, QOL and Q max at the same time among the three groups( P>0.05).The incidence of postoperative urinary incontinence after one week in group A and group B were significantly lower than that in group C[2.2%(2/89) vs. 12.3%(10/81) vs. 34.7%(25/72), P<0.05], and the incidence of postoperative urinary incontinence after one week in group A was significantly lower than that in group B ( P<0.05). The incidence of postoperative urinary incontinence after one month in group A and group B were significantly lower than that in group C[0(0/89) vs. 6.2%(5/81) vs. 22.2%(16/72), P<0.05], and the incidence of postoperative urinary incontinence after one month in group A was significantly lower than that in group B( P< 0.05). Conclusions:Holmium laser enucleation of the prostate with anterior lobe-sparing can significantly reduce the incidence of urinary incontinence after operation, which is worthy of clinical application.
