Medium To Long-term Clinical Efficacy Of Transurethral Holmium Laser Enucleation And Plasma Electrotomy In The Treatment Of Benign Prostatic Hyperplasia

Objective:In this project,patients with benign prostatic hyperplasia(BPH)who underwent holmium laser enucleation of prostate(HoLEP)and transurethral plasmakinetic resection of the prostate(TUPKRP)were followed up for 3 years,through analysis and comparison of the efficacy and safety of the two surgical methods within 3 years,in order to provide a clinically stable and safe surgical method for BPH patients.Methods:This study retrospectively analyzed BPH patients who underwent HoLEP and TUPKRP surgery in our hospital from January 2013 to March 2016,A total of 181 BPH patients who met the requirements were included,Among them,88 cases underwent HoLEP operation and 93 cases underwent TUPKRP operation.Systematic records and evaluation of patients' perioperative indicators,international prostatic symptom score(IPSS),quality of life score(QOL),international prostatic symptom score-voiding(IPSS-V),international prostate symptom score-storage subscore(IPSS-S),maximum urinary flow rate(Qmax),postvoid residual(PVR)and adverse events within 3 years after operation,the above indicators were compared between groups and statistical analysis was performed.Results:1.Comparison of basic data between the two groups:There was no significant difference in the preoperative basic data between HoLEP and TUPKRP groups(P>0.05),and the data of the two groups were comparable.2.Comparison of perioperative data between the two groups: The surgery was successfully completed in the two groups,In the case of similar operation time,the weight of the glands removed in the HoLEP group was significantly heavier than in the TUPKRP group(P <0.01);The postoperative bladder irrigation time,urinary indwelling time,and postoperative hospital stay in the HoLEP group were significantly shorter than those in the TUPKRP group(P<0.01);There was no significant difference in Pre-/post-operative blood sodium concentration and between groups,Preoperative hemoglobin concentration between the two groups,and Pre-/post-operative hemoglobin concentration in HoLEP group(P>0.05),but the parameters of postoperative hemoglobin concentration in the TUPKRP group were significantly lower than those before operation(P<0.05).And the comparison of postoperative hemoglobin concentrations between the two groups showed statistically significant differences(P <0.05).3.Comparison of postoperative follow-up data between the two groups:The PVR,Qmax,IPSS score,IPSS-S score,IPSS-V score,QOL score at each stage of the two groups after 3 years were significantly improved compared with those before the operation(P<0.05);There was no significant difference between the two groups in the comparison of PVR within 3 years(P>0.05);The Qmax in the 2nd and 3rd year after HoLEP group was better than TUPKRP group(P<0.05);The total IPSS score,IPSS-S scoreat at 1 months,and QOL score at 6 months after operation in the HoLEP group were lower than those in the TUPKRP group(P<0.05);The 1-month,1-year and 3-year follow-up of IPSS-V in HoLEP group were better than TUPKRP(P <0.05);The QOL satisfaction in HoLEP was higher than that in the TUPKRP group in January and June,and the difference was statistically significant(P <0.05).4.Comparison of the incidence of complications between the two groups: There were no surgical complications during the operation in the HoLEP group,but 2(2.2%)and 1(1.1%)cases of transfusion / blood products and capsular perforation occurred in the TUPKRP group,respectively;There was no significant statistical difference between the two groups(P>0.05);There was no significant difference in the incidence of various complications between the short-term(within 1 week)postoperative period(P> 0.05),but the overall complication rate in the HoLEP group was significantly lower than that in the TUPKRP group(P <0.05);There were no intermediate to long-term complications in the HoLEP group,while 1(1.1%)case of urethral stricture and 1(1.1%)recurrence of residual gland occurred in the TUPKRP group;There was no statistically significant difference between the two groups(P> 0.05).Conclusions:1.Both procedures are safe and effective,but the short-term total complication rate after HoLEP is lower,no intermediate to long-term complications occurred,and it is safer and more reliable.2.HoLEP removes the glands more thoroughly,has high surgical efficiency,and recovers quickly after surgery.3.HoLEP has more obvious improvement on lower urinary tract symptoms than TUPKRP,especially the improvement of symptoms during urination,and the intermediate to long-term treatment effects are stable and lasting.