Abstract
The disadvantage of bipolar and holmium enucleation in transurethral surgery of benign prostatic hyperplasia (BPH) is the frequent postoperative urination disorders. To increase the effectiveness of surgical treatment, a modification of the surgical technique is necessary.Objective: to compare the perioperative results of endosurgical treatment of large sized BPH using transurethral bipolar (TUEB), laser (HoLEP) and modified laser prostate enucleation (HoLEP-M) methods. Patients and methods: A randomized prospective study was conducted according to the results of surgical treatment of 1104 patients with BPH with a volume of 80 to 350 cm3, divided by methods of endoscopic enucleation of the prostate. A mod-ification of the HoLEP technique was to optimize access to the surgical site with the designation of new anatomical landmarks.Results: Comparison of surgical methods showed their equivalence in the volume of removed tissue, the low frequency of hemorrhagic and infectious complications, the dynamics of urological indicators in the delayed period. TUEB has the least parameters for the time of surgical intervention (98.2 ± 2.24 min.), the vol-ume of blood loss (65.5 ± 1.83 ml), the terms of postoperative catheterization of the bladder (2.0 ± 0.32 days), and the days of hospitalization (3.2 ± 0.40 days). The safety of laser methods is higher than TUEB, during which 3.1% of closed perforations of the prostatic capsule and bladder were observed (versus 0.8-1.5% with laser methods). Modification of the HoLEP technique allows reducing the frequency of late dysuric disorders by 2-3 times, urinary incontinence by 3.4-4 times, cicatricial complications by 1.7-2 times.Conclusion: Bipolar and laser methods of transurethral enucleation of the prostate of large sizes are comparable by criteria of complete removal of prostatic tissue, effectiveness and tolerability in patients with thrombohemorrhagic risk. In terms of the frequency of intraoperative injuries, the safety of laser methods is higher due to the reduced penetrating ability of laser energy. Modification of surgical access to the prostate preserves the prostatic urethra as much as possible and is a promising measure for the prevention of late obstructive and functional complications of transurethral interventions.
Highlights
В то же время частота отсроченных послеоперационных нарушений мочеиспускания остается значительной – 4,9-12,5% после HoLEP и 3,39,0% после П-ТУЭП, что снижает качество жизни оперированных пациентов и иногда требует повторных хирургических пособий [12,13]
Patients and methods: A randomized prospective study was conducted according to the results of surgical treatment of 1104 patients with benign prostatic hyperplasia (BPH) with a volume of 80 to 350 cm3, divided by methods of endoscopic enucleation of the prostate
Comparison of surgical methods showed their equivalence in the volume of removed tissue, the low frequency of hemorrhagic and infectious complications, the dynamics of urological indicators in the delayed period
Summary
В то же время частота отсроченных послеоперационных нарушений мочеиспускания (инконтиненция, ургентность позывов, поллакиурия, ноктурия и др.) остается значительной – 4,9-12,5% после HoLEP и 3,39,0% после П-ТУЭП, что снижает качество жизни оперированных пациентов и иногда требует повторных хирургических пособий [12,13]. Но если проблемы восстановления континенции связаны с нестабильностью детрузора или с обострением воспалительного процесса, то выявленные нарушения протекают более длительно и требуют активных методов лечения [15,16]. Обусловливающим скорость восстановления нормальных параметров мочеиспускания, является хирургическая техника трансуретральной энуклеации простаты [17,18]. Классическая техника их выполнения приводит к изменению уретровезикальных углов, стереометрического положения наружного сфинктера МП в малом тазу и связана с риском повреждения передней части уретры и волокон сфинк-
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