比較不同攝護腺鈥雷射剜除手術方式以期降低術後短暫性尿失禁之發生率

林崇裕¹、林君軒、吳文正¹、李經家¹、柯宏龍¹、溫聖辰¹

高雄醫學大學附設醫院 泌尿部

Comparison of different en bloc HoLEP techniques to reduce the rate of postoperative transient urinary incontinence

Chung-Yu Lin¹, Chun-Hsuan Lin¹, Wen-Jeng Wu¹, Ching-Chia Lee¹, Hung-Long Ko¹, Sheng-Chen Wen¹

Department of Urology1, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Purpose: To investigate postoperative factors in transient urinary incontinence (TUI) after different en bloc holmium laser enucleation of the prostate (HoLEP) techniques and use of 3 horseshoe-shaped incisions.

Materials and Methods: Between January 2017 and October 2019, 169 consecutive patients underwent different HoLEP techniques using original en bloc, en bloc with early mucosal strip detachment, and 3 horseshoe-shaped incisions to treat bladder outlet obstruction. Preoperative variables and surgical quality indexes between groups were recorded. TUI was defined as any hygienic or social problem caused by involuntary loss of urine at 2 weeks postoperatively. Postvoid residual urine (PVR), maximum urinary flow rate (Q max), and International Prostate Symptom Score (IPSS) were assessed

Results: Compared with the original en bloc and en bloc with early mucosal strip detachment techniques, patients in the 3 horseshoe-shaped incision group had a statistically significant decrease in TUI (3.5% vs 9.7% and 14%, respectively; p = 0.001) and IPSS score (p = 0.031). Although not statistically significant, the 3 horseshoe-shaped incisions group showed a trend toward a faster enucleation time (p = 0.051). No life-threatening intraoperative complications were recorded among the 3 groups.

Conclusions: Use of 3 horseshoe-shaped incisions in an en bloc HoLEP technique was shown to prevent urethral sphincter damage with a low rate of postoperative TUI. Further comparative assessment of long-term data in a multicenter trial is required.