Transurethral prostate enucleation with 2 μm laser in the treatment of benign prostatic hyperplasia / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in the treatment of benign prostatic hyperplasia (BPH). Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm laser under continuous epidural anesthesia or laryngeal mask anesthesia. The patient′s, average age was 67±9 yrs (52 to 85 yrs). Of whom, 10 patients had a history of urinary retention. The mean prostate volume was 72.5±17.6 ml (45 to 158 ml). Two deep trenches were cut at the 5 and 7 o, clock position from the bladder neck to the verumontanum. The incision continued to the urethral mucosa and submucosa along with the verumontanum bilaterally in an arc-shape and ended at the internal arc of urethral sphincter. Then the urethral mucosa at the level of the verumontanum was cut and the surgical capsule plane was identified. A retrograde blunt dissection was made along the surgical capsule plane with the resectoscope sheath front-end, and the sheath was swung from side to side to extend the capsule plane. The significantly enlarged middle lobe was treated with laser vaporization resection. In the same way, a trench was made at the 12 o, clock position, and the lateral lobe were removed by the sheath from the verumontanum level, finally only two cord-like pedicles were kept at the 1 and 11 o, clock position at the bladder neck, so that the removed gland tissue was fixed and hung in the gland fossa. For prostate volume less than 60 ml, the laser vaporization resection was carried out directly. If the prostate volume was greater than 60ml, transurethral resection would be performed instead of laser vaporization resection. With 4% mannitol irrigation, the enucleated prostate tissue was then cut into small pieces and washed out by a Braun plastic bottle through the resectoscope sheath. Intraoperative bleeding, operative time, catheterization time, postoperative voiding status, maximum urinary flow rate (Qmax) and length of hospital stay were recorded and analyzed. Results All patients successfully completed the transurethral prostate enucleation. The average operative time was 74±12 min (45-150 min). Five cases required blood transfusion. There was no recorded urethral stricture and no urinary incontinence except for one patient who recovered 1 mon after the operation. The follow-up time was 2-6 mon. The average Qmax was 6.3±0.6 ml/s before and increased to 17.5±1.5 ml/s after the operation. The international prostate symptom score (IPSS) and quality of life (QOL) were reduced from 26.4±5.5 and 4.6±0.5 to 9.3±2.1 and 2.8±0.3 after the operation, respectively, P<0.01. Postoperative secondary bleeding was not observed. Conclusions Transurethral prostate enucleation with 2 μm laser for BPH is a safe and effective minimally invasive treatment. Its efficacy is superior to open surgery, and even better than TURP.