The effect of holmium laser enucleation of the prostate in the treatment of small volume benign prostate hyperplasia / 中华泌尿外科杂志

ABSTRACT

Objective:To investigate the efficacy and safety of transurethral Moses holmium laser enucleation of the prostate (MoLEP) in the treatment of small-volume benign prostatic hyperplasia (BPH).Methods:The clinical data of 132 patients with small BPH (prostate volume <40 ml) who underwent MoLEP from October 2017 to April 2020 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively.The age of the patients was (63.93±5.21) years old, including 12 patients with cystolithiasis. The prostate volume of 132 patients was (32.16±7.81) ml, the preoperative international prostate symptom score (IPSS) was 23.00(15.00-34.00), the quality of life score (QOL) was 5(2-6), the maximum urinary flow rate (Q max) was 7.80(0.80-9.80)ml/s and residual urine volume (PVR) was 158(51-409) ml. 89 patients had the preoperative maximum detrusor contractility (64.23±8.11) cmH 2O. Surgical methods: the 120 W Moses laser platform(Lumenis Inc)was used, the cutting power was adjusted to 80 W (2.0J×40Hz) (narrow pulse width mode), and the hemostatic power 24W (0.8J×30Hz) (wide pulse width mode). Patients with bladder calcifications underwent Moses laser bladder stone lithotripsy.After the initial resection by the level of verumontanum was performed, an anatomic plane was exposed and carried forward until the bladder neck. If prostate stones were found, Moses holmium laser lithotripsy can be performed directly. After operation, the bladder was continuously flushed with normal saline. The catheter was removed 24 hours after the operation. The operation status, intraoperative and postoperative complications were recorded. IPSS, QOL, Q max and PVR were followed up 3 months after surgery. Postoperative urinary incontinence is defined as the need for 2 pads or more within 24 hours. Results:The operations of 132 cases (including 12 cases with bladder stones) were successfully completed. 30 cases with prostate calcifications were found during the operation. The operation time (enucleation time) was (16.83±4.03) min. There were no perioperative complications such as blood transfusion, transurethral resection syndrome, urinary retention and venous thromboembolism. No bladder neck contracture or recurrence of bladder stones was found after surgery. Postoperative urethral stricture occured in 2 cases (1.5%), and postoperative urinary incontinence in 27 cases (20.5%). There were 102 cases (77.3%) with chronic interstitial inflammatory cell infiltration. Three months after operation, IPSS was 7(0-14), QOL was 2(0-5), Q max was 17.55(9.40-26.50)ml/s and PVR was 27(0-46) ml, which were significantly improved compared with preoperatively( P<0.05). Conclusions:MoLEP can significantly improve lower urinary tract symptoms (LUTS) and life quality of patients with small-volume BPH.At the same time, the incidence of complications such as urethral stricture and urinary incontinence is lower. The operation is safe and reliable, and bladder stone lithotripsy can be performed at the same time.