Analysis of peri- and postoperative results of laser enucleation of the prostate using various techniques

Мұқаба

Дәйексөз келтіру

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Аннотация

Introduction. Several techniques are used for laser enucleation of benign prostate hyperplasia, including two- and three-lobe enucleation, enucleation of all lobes in a single block (en-bloc), and enucleation of all nodes in a single block without longitudinal incisions (total en-bloc).

Aim. A prospective and retrospective analysis of the results of two-lobe, en-bloc, and total en-bloc using thulium fiber laser enucleation of the prostate (ThuFLEP) techniques was performed.

Methods. The study included a retrospective and prospective comparative analysis of the peri- and postoperative results of ThuFLEP using several techniques. Patients with benign prostatic hyperplasia causing bladder outlet obstruction (IPSS>20, Qmax<15) were undergone to ThuFLEP from January 2015 to May 2022. All patients were examined prior to and 1, 3, and 6 months after the procedure. In the pre- and postoperative period, the age of the patients, prostate volume, level of prostate-specific antigen, functional parameters (IPSS, post-void residual, Qmax, and QoL), the stress urinary incontinence were evaluated. In addition, the following intraoperative parameters were assessed: duration of the procedure, enucleation rate, morcellation rate, and mass of enucleated tissue.

Results. We found 450 patients who underwent thulium fiber laser enucleation of prostate hyperplasia (ThuFLEP). Three laser enucleation techniques were used, including two-lobe (n=148; group A), en-bloc (n=150; group B), and total en-bloc without longitudinal incision (n=152; group C). The mean prostate volume was comparable between groups. The mean operation time for the total en-bloc technique (group C) was less compared to the other two techniques (58.9±30.1 vs. 68.8±30.6 for group A and 67.4±30.1 min for group B, respectively; p<0.005). The mean enucleation rate in group C was higher compared to groups A and B (2.3±0.78 vs. 1.9±0.74 and 1.9±0.69 g/min, respectively; p<0.005). The mean morcellation rate in all three groups was comparable (2.8±1.7, 3.0±1.1, and 2.9±2.1 g/min; p>0.05). After 6 months, there were no differences in functional results, according to the IPSS, PVR, Qmax, and QoL.

Conclusion. The two-lobe, en-bloc, and total en-bloc techniques were comparable in functional results and the complication rate. Total en-bloc enucleation showed the higher enucleation efficiency.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Ch. Dibiraliev

I.M. Sechenov First Moscow State Medical University

Хат алмасуға жауапты Автор.
Email: hinghiz.dibiraliev@yandex.ru

urologist, Ph.D. student, Institute for Urology and Reproductive Health

Ресей, Moscow

Ch. Abdulaev

I.M. Sechenov First Moscow State Medical University

Email: abdulaev.ch@yandex.ru

resident, Ph.D. student, Institute for Urology and Reproductive Health

Ресей, Moscow

S. Danilov

I.M. Sechenov First Moscow State Medical University

Email: spdanilov@gmail.com

Ph.D., urologist, Institute for Urology and Reproductive Health

Ресей, Moscow

A. Dymov

I.M. Sechenov First Moscow State Medical University

Email: alimdv@mail.ru

Ph.D., Institute for Urology and Reproductive Health

Ресей, Moscow

R. Sukhanov

I.M. Sechenov First Moscow State Medical University

Email: rb_suhanov@mail.ru

Ph.D., assistant, Institute for Urology and Reproductive Health

Ресей, Moscow

E. Bezrukov

I.M. Sechenov First Moscow State Medical University

Email: eabezrukov@rambler.ru

Ph.D., MD, professor of the Institute for Urology and Reproductive Health

Ресей, Moscow

Әдебиет тізімі

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2. Fig. 1. Diagram of a two-field laser enucleation technique A — dissection of the tissue at the seminal tubercle on the right and the entry of the layer between prostate hyperplasia and the surgical capsule; B — enucleation of the right lobe; C - dissection of the tissue at 12 hours of the conventional dial; G — enucleation of the left lobe [13]

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3. Fig. 2. Diagram of the en-bloc laser enucleation technique A — dissection of the tissue to the right and left of the seminal tubercle, continuation of circumferential incisions on both sides; B — the process of enucleation of prostatic hyperplasia with a single block with dissection of hyperplasia for 12 hours of the conventional dial; C — enucleated prostatic hyperplasia is pushed into the lumen of the bladder with a single block [15]

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4. Fig. 3. Scheme of total en-bloc laser enucleation technique 1 — visualization of the fold of the external sphincter (Nesbit sign); 2 — dissection of tissue in the area of the fold of the external sphincter; 3 - dissection of tissue to the right and left of the seminal tubercle; 4 - continuation of incisions on both sides along the circumference up to 12 hours of the conventional dial; 5 — enucleation of the right and left lobes along the lateral surfaces; 6 — transverse incision for 6 hours of the conventional dial; 8 — enucleation of the right and left lobes along the lateral surfaces; 9 — enucleation of hyperplasia tissue along the upper semicircle; 10 — enucleation of hyperplasia tissue along the lower semicircle; 11 — enucleated hyperplasia tissue is pushed into the lumen of the bladder [7]

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