Гольмиевая лазерная энуклеация предстательной железы – новый «золотой стандарт» хирургического лечения ДГПЖ в г. Москве

Abstract

Introduction. Benign hyperplasia of prostate (BPH) is still one of the most common urological diseases of elderly and senile age. Transurethral resection of prostate (TURP) is considered as a gold standard of BPH surgical treatment. However, TURP is recommended for prostates with volume up to 80 cm3 . In this connection new minimally invasive methods are being searched permanently to improve the results of surgical treatment of patients with prostate volume exceeding 80 cm3 . Materials and methods. The results of 150 cases of HoLEP performed by a single surgeon in the period from June 2018 till December 2019 are analyzed. Average age 67,8 (±7,7) years. Preoperative examination besides general clinical tests, IPSS, TRUS of prostate, uroflowmetry, US-measure of postvoiding residual volume (PVR), PSA testing. The median of prostate volume was 74 (29-272) сm3 , 94 (62%) patients were able to urinate with average Qmax of 7 (2-25) ml/sec, average IPSS score was 21.6 ± 4.4, chronic urinary retention (PVR > 100 ml) was diagnosed in 44 (29%) patients. 56 (38%) patients had suprapubic catheter. Hemoglobin before surgery 142.6 ± 12.3 g/l. Surgery was performed with holmium laser Lumenis Pulse 100H. Postoperative control tests were performed before discharge of patients from the hospital. Results. The median of surgery time was 90 (30 – 180) min. The mean estimated blood loss was 133,4 ± 14,3 g/l. We drained bladders with urethral catheters for 3.0 (1-5) days in average. Average Qmax was 22,9 ± 8,6 ml/sec and PVR was 55,0 ± 8,0 ml. Average hospital stay was 5,0 (2-15) days. Intra- and postoperative complications were: perforation of bladder wall in 4,6% cases, perforation of prostate capsule in 7.3% patients, residual tissue in the bladder after morcellation in 2,6% cases, clot retention in 5,3% cases, 1,3% patients needed blood transfusion, acute urinary retention after urethral catheter removal was in 8.6% cases, acute bacterial prostatitis in 3.3% patients, acute urethritis in 2.6% cases, acute epididymo-orchitis in 4% cases, stress urinary incontinence in 14% patients. Discussion. At present, the search for new techniques to improve the quality of surgical treatment of BPH, including with a large pancreatic volume, is not stopped. The developed «laser technologies» are aimed at reducing the risk of complications and improving the quality of life of patients in the postoperative period. The results of numerous studies and our results carried out indicate the high clinical efficiency of the holmium laser, the possibility of its application for large and gigantic pancreatic sizes. It should be noted that the safety level of HoLEP is higher, the period of bladder catheterization is shorter, the patient's stay in the hospital and financial costs are less, and the quality of life after surgery is higher. The results obtained are comparable with the data of the international literature and indicate the high efficiency and relative safety of HoLEP. Conclusion. The obtained results indicate the high efficiency and relative safety of HoLEP in the surgical treatment of BPH, regardless of its volume. The results obtained allow us to assert that there is a new «gold standard» for surgical treatment of BPH and consider the possibility of introducing HoLEP into the standards of medical care for urological patients with BPH.