比較TUEP與TURP在治療大體積前列腺中的療效與安全性：單一醫學中心回顧性分析

蔡勝閔¹、李高漢¹、劉建良、蘇家震、謝昆霖、林才揚、黃冠華¹

台南奇美醫學中心 外科部 泌尿科¹

Comparative Efficacy and Safety of TUEP vs. TURP in Treating Large Volume Prostate: A Single-Center Retrospective Analysis

Sheng-Min Tsai¹、Kau-Han Li¹、Chien-Liang Liu¹、Chia-Cheng Su¹、Kun-Lin Hsieh¹、Chye-Yang Lim¹、Steven K. Huang¹

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

Purpose:

While Transurethral Resection of the Prostate (TURP) has traditionally been the benchmark for benign prostatic hyperplasia (BPH) surgery, Transurethral Enucleation of the Prostate (TUEP) using laser or bipolar technology is gaining traction for large volume cases. This investigation assesses the relative efficacy and safety of TUEP versus TURP in managing severe BPH.

Material and Methods:

This retrospective study analyzed severe BPH cases with prostate volumes exceeding 50 grams, treated via TURP or laser TUEP at our institution from January 2017 to August 2021. The cohort consisted of 23 patients who underwent TURP and 133 who received laser TUEP. We evaluated preoperative prostate volume, surgical duration, hospitalization, postoperative improvements in maximum urinary flow rate (Qmax), and perioperative complication incidence.

Results:

The TURP group presented a higher incidence of acute urinary retention (47.8% vs. 36.1%) and larger average prostate volume (163.74g vs. 144.55g). Both groups had similar operation times and lengths of hospital stay. Postoperative outcomes favored the TUEP group, which exhibited greater improvement and lower complication rates (43.4% vs. 31.6%). Notably, TUEP patients had a reduced need for blood transfusions (10.5% vs. 30.4%) but experienced a slightly increased occurrence of short-term stress urinary incontinence (9% vs. 4.3%). In subsequent follow-ups, only one patient required a second TURP.

Conclusions:

TUEP demonstrates superior efficiency and safety compared to TURP in treating patients with large volume BPH, notably lowering complication and blood transfusion rates. The findings endorse the adoption of TUEP as the preferred surgical modality for severe BPH.