The Efficacy Of Holmium Laser Enucleation Of The Prostate For Large Prostatic Adenoma In Patients With Benign Prostatic Hyperplasia

Objective As a common benign progressive disease in urology,BPH has been plaguing middleaged and elderly male patients,often affecting their physical and mental health to varying degrees.Surgical treatment is the main treatment for BPH,and prostate volume is one of the main influencing factors for urologists to choose surgical methods.Holmium laser enucleation of the prostate is a new surgical method in the 21 st century,which is increasingly favored by urologists.Therefore,this paper will discuss the efficacy and safety of HoLEP in the treatment of BPH with large volume(> 80ml),and summarize the experience of cure.Patients and Methods In this paper,128 patients with large volume BPH who underwent HoLEP in the second hospital of Tianjin Medical University from October 2017 to December 2018 were analyzed retrospectively.General clinical data such as patient age,prostate volume,PSA,concomitant other systemic diseases,International Prostate Symptom Score(IPSS),Quality of Life(Qo L),Post-Voiding Residual volume(PVR),and urinary peak flow rate(Qmax)were recorded.The perioperative parameters such as enucleation time,smash time,enucleate prostate weight,postoperative bladder irrigation time,indwelling catheter time,postoperative hospital stay time,hemoglobin loss value and complications were recorded.IPSS,Qo L,PVR,Qmax and the incidence of complications were evaluated at 1 month,6 months and 1 year after surgery.The follow-up data were compared with the preoperative baseline data to assess the efficacy and safety of HoLEP in the treatment of large BPH.Results All patients were successfully operated,and no cases were converted to TURP or open prostatectomy.The average resection weight of prostate was(89.70 ± 24.03)g,the hemoglobin loss was(10.07 ± 6.83)g / L,the enucleation time was(38.85 ± 9.11)min,the smash time was(8.48 ± 3.51)min,the enucleation efficiency was(2.31 ± 0.30)g / min,the smash efficiency was(11.46 ± 3.29)g / min,the postoperative bladder irrigation days were(1.08 ± 0.29)days,the catheter indwelling days were(2.01 ± 0.31)days,and the postoperative hospitalization days were(2.95 ± 0.42)days.The results of postoperative follow-up showed that there was a dramatic reduction in LUTS of the patients.Compared with the baseline data,the postoperative Qmax increased considerably,IPSS,PVR and Qo L decreased significantly(P < 0.001).Complications occurred in 23 cases,including 8 cases of stress urinary incontinence,1 case of urethral stricture,3 cases of mild damage to bladder mucosa,5 cases of urinary tract infection,5 cases of urinary retention after catheter removal,and 1 case of blood transfusion,all of which improved after symptomatic treatment.Conclusions HoLEP is safe,effective and reliable in treating large volume BPH,which is worthy of further promotion and application.The application of HoLEP in the treatment of large-volume BPH is relatively difficult,and requires higher technical for the operator.The safety of operation can be improved by careful perform,finding the right capsule layer and effective hemostasis.