经尿道前列腺钬激光整叶剜除术的单中心大样本临床研究

Single-center large-sample clinical study on transurethral holmium laser enucleation of the prostate with en-bloc technique

目的:分析保留膀胱颈的整叶法经尿道前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的有效性和安全性,探讨其在尿控及性功能保护方面的意义。方法:回顾性分析2012年6月—2022年6月在南京医科大学第一附属医院接受保留膀胱颈的整叶法HoLEP治疗,并有完整信息的3116例BPH患者的临床资料,记录患者基线资料、围手术期数据,随访时间12个月。排尿功能采用国际前列腺症状评分(international prostate symptom score,IPSS)、最大尿流率(Qmax)、残余尿(post-void residual urine,PVR)和生活质量(quality of life,QoL)评分进行评估。对于术前有性活动并有正常顺行射精的213例患者,进一步评估勃起功能及射精功能。结果:平均手术时间为(68.3±15.4)min,切除腺体重量为(55.3±16.7)g,估计失血量为(61.2±22.6)mL;平均住院时间和术后留置导尿管时间分别为(5.1±3.3)d和(2.0±1.4)d。术后第2天进行拔管,首次拔管失败率为4.5%(141/3116)。与术前比较,术后3、6、12个月IPSS、Qmax、PVR及QoL等指标均有显著改善(P<0.05),且在随访过程中持续稳定。术后3个月尿失禁发生率为11.1%(346/3116),多数患者在术后1年内恢复,长期尿失禁23例(0.7%)。对于性功能评估亚组的213例患者,术后国际勃起功能指数(IIEF-5)评分及勃起硬度分级量表(EHGS)均无显著变化(P>0.05);术后逆行射精患者共61例(28.6%)。所有患者术后均无射精痛。结论:整叶法HoLEP治疗BPH是安全有效的,术中采用保留膀胱颈的技术可以有效改善尿控功能,保护性功能,尤其是减少逆行射精的发生。

Objective:To study the efficacy and safety of holmium laser enucleation of the prostate(HoLEP)with en-bloc and bladder neck preservation technique for the treatment of benign prostatic hyperplasia(BPH),and to explore its significance in urinary control and sexual function protection.Methods:We retrospectively analyzed the clinical data of 3116patients who were treated with HoLEP with en-bloc and bladder neck preservation technique at the First Affiliated Hospital of Nanjing Medical University from June 2012to June 2022.The follow-up period was 12months,and the baseline characteristics,perioperative and outcome data were recorded.The voiding function was assessed by the International Prostate Symptom Score(IPSS),maximum urinary flow rate(Qmax),post-void residual urine(PVR),and quality of life(QoL)score.Erectile and ejaculatory function were further assessed in 213patients who were sexually active preoperatively and had normal antegrade ejaculation.Results:The mean operative time was(68.3±15.4)min,and the mean weight of resected gland was(55.3±16.7)g,the estimated blood loss was(61.2±22.6)mL,the mean length of hospitalization and postoperative catheterization were(5.1±3.3)and(2.0±1.4)days,respectively.The catheter was removed at second postoperative day,and the failure rate of the first removal was 4.5%(141/3116).Compared with the preoperative level,IPSS,Qmax,PVR,and QoL were significantly improved at 3,6,and 12months postoperatively(P<0.05)and contin-ued to stabilize during the follow-up.The incidence of urinary incontinence at 3months was 11.1%(346/3116).Most patients recovered within one year postoperatively,but there were 23cases of persistent urinary incontinence(0.7%).For the 213patients in the sexual function assessment subgroup,there was no significant change in the International Index of Erectile Function(IIEF-5)score or the Erectile Hardness Grading Scale(EHGS)after operation(P>0.05);a total of 61patients(28.6%)suffered from retrograde ejaculation after the operation.No patients had ejaculatory pain after surgery.Conclusion:HoLEP with en-bloc and bladder neck preservation technique is safe and effective,for it can effectively improve urinary control function,protect sexual function,and significantly reduce the incidence of retrograde ejaculation.