Late Complications Of Holmium Laser Enucleation Versus Plasmakinrtic Resection Of The Prostate

Objective:To evaluate late complications of two types of prostatecomy, holmium laser enucleation of prostate(HoLEP) and transuretheral plasmakinetic resection of prostate (PKRP) on BPH patients.Methods:Between January 2009 and June 2010,totally 120 patients who had benign prostatic hyperplasia were enrolled into two groups:HoLEP and PKRP. Patients were assessed before surgery, and at 1,3 and 6 months followup visits. Subjective symptoms were scored and compared by the International Prostate Symptom Score (IPSS), quality of life(QOL), International index of erectile function-5 (IIEF-5), libido before and after operation. The incidence of rebleeding, Infection, urethral stenosis, bladder neck contracture, erectile dysfunction (ED),retrograde ejaculation and urinary incontinence after surgery were also recorded.Results:The complete follow-up patients were 50 in HolEP group and 48 in PKRP group respectively(1)The score of IPSS and QOL in the two groups both decreased rapidly in postoperative 1,3 and 6 months, with no statistical significant difference between the two groups; (2)IIEF-5 score decresed postoperatively in both groups; The significant differences of IIEF-5 were favoring HoLEP compared with PKRP in postoperative 3,6 months;(3) The incidence of rebleeding, Infection, urethral stenosis, bladder neck contracture were2%(1/50),4%(2/50),4%(2/50),2%(1/50) respectively in HoLEP group. In PKRP group the incidence were 4.2%(2/48) 6.25%(3/48),4.2%(2/48), 4.2%(2/48), with no statistical significant difference between the two groups.(4)The incidence of erectile dysfunction were 6%,16.7% in HolEP and PKRP respectively which showed no significant difference between the two surgical approaches.(5)The rate of retrograde ejaculation of HoLEP,PKRP were 16% and 33.3% respectively which showed significant statistical difference favoring HoLEP after surgery between two groups;(6)The incidence of urinary incontinence occurred in HoLEP group was 17/50 (34%) in postoperative 1 month.At the 3rd month it was 8/50 16%.followed up to 6 months,there still exist 4 cases(8%) of urinary incontinence. In PKRP group the incidence of urinary incontinence occurred after 1 and 6 months were 12.5% and 10.4% respectively. There showed significant statistical difference on urinary incontinence between the two surgical approaches in one month after operation.Conclusion:HoLEP and PKRP may both improve symptoms and cause some common late complication,Among which HoLEP is superior to PKRP in retrograde ejaculation,However,HoLEP is inferior to PKRP significantly in urinary incontinence early after surgery.