Comparative Study Of Moses Holmium Laser Enucleation And Plasmakinetic Bipolar Resection Of The Prostate

Background and PurposeBenign prostate hyperplasia(BPH)is one of the common diseases of elderly men,and its incidence gradually increases with age.The main clinical symptoms are frequent urination,urgency,dysuria,and often accompanied by incomplete urination,which seriously affects the quality of life.Transurethral resection of prostate(TURP)is a standard surgical treatment method for benign prostatic hyperplasia promoted by the guidelines of the American Urological Association.The clinical effect is definite,but there are many postoperative complications.Transurethral bipolar plasma kinetic resection of prostate(PKRP)is a new bipolar electrosurgical technology developed on the basis of unipolar electroresection[1].The clinical effect is similar to transurethral resection of the prostate(TURP),and to a certain extent,it can avoid defects such as intraoperative perforation,heavy bleeding,and electrosurgical syndrome(TURS).It has gradually become the ideal surgical procedure for BPH[2].However,in the face of patients with large benign prostatic hyperplasia,patients with coagulopathy,and BPH patients who need to take anticoagulant drugs for a long time,the implementation of PKRP still has certain limitations,and the clinical effect after surgery is also affected.Therefore,clinical surgeons hope to seek a new minimally invasive surgical method to treat BPH,which can achieve a clinical treatment effect similar to or better than PKRP,and at the same time reduce the physical and mental pain and burden of patients as much as possible.In recent decades,with the development of laser technology,transurethral holmium laser enucleation of the prostate(HoLEP)is gradually regarded as a safe and effective surgical method for the treatment of BPH overlooking the volume of the prostatic hyperplasia.For large prostate glands,especially those with a volume of more than 100ml,HoLEP can even achieve a complete enucleation outcome which is similar to open surgery[3].The maximum urine flow rate(Qmax),International Prostate Symptom Score(IPSS),quality of life index(Qol)of the patients who has gone through Holep in short-term is similar to the outcome of those who go through TURP.The reason why the development of holmium laser technology has been restricted is that the maximum power of the holmium laser platform is not high enough because the water absorbs the holmium laser well.In 2017,the American Lumenis medical company developed the Moses technology holmium laser platform(Lumenis Moses Pulse 120H),with a maximum power go up to 120W.Through the unique pulsed laser mode,the holmium laser energy is transmitted in the form of low depletion,which greatly improves the capable Energy on the target body.Although the first application of the Moses laser is in kidney stones,considering the overlapping of BPH and stone treatment technology,using Moses holmium laser treatment on BPH is a natural progress.Our center has been conducting PKRP for many years and has accumulated a lot of clinical experience.After the development of the Moses laser in 2017,we introduced the Moses holmium laser platform in March 2018 and immediately launched the transurethral Moses holmium laser enucleation of the prostate(m-HoLEP).In order to compare and analyze the clinical treatment effects of the two surgical methods,this study retrospectively analyzed the data of patients undergoing surgical treatment of benign prostatic hyperplasia in our hospital from March 2018 to July 2019.After the short-term clinical data,comparative analysis of the short-term clinical efficacy of m-HoLEP and PKRP during and after operation.Objects and methodsRetrospectively analyzed the data of patients undergoing surgical treatment of benign prostatic hyperplasia in our hospital from March 2018 to July 2019,and the medical records were collected according to the surgical method and were divided into the transurethral prostate Moses holmium laser enucleation group(m-HoLEP group),42 cases)and transurethral bipolar plasmatomy group(PKRP group,47 cases).The surgical indicators(operation time,intraoperative blood loss,catheter indwelling time,bladder irrigation time,average gland resection rate,PVR,Qmax,IPSS and QOL scale)were compared and analyzed between the two groups.The count data is expressed as mean±standard deviation(X±s).If two independent samples conform to the normal distribution,t test is performed;if they do not conform to the normal distribution,the Wilcoxon two-sample comparison method is used to test.Chi-square test was used to compare the count data.SPSS21.0 was used for data processing.P<0.05 was considered statistically significant.ResultsCompared with the short-term postoperative efficacy of m-HoLEP and PKRP,it was found that m-HoLEP was superior to PKRP in terms of intraoperative blood loss,catheter retention time,bladder irrigation time,average gland resection rate,Qmax,etc.(P<0.05);The operation time of m-HoLEP is slightly longer than PKRP but not statistically significant(P>0.05);the two surgical methods are equivalent in postoperative PVR,IPSS and Qol.ConclusionCompared with PKRP,m-HoLEP has a higher gland resection rate,while intraoperative blood loss,postoperative recovery time and complications are significantly less than PKRP,and m-HoLEP can shorten the learning curve to a certain extent.It is a good method for the treatment of BPH and is worthy of clinical promotion.