全葉銩雷射攝護腺剜除之臨床經驗

劉永浩、曹智惟、蒙恩、吳勝堂、查岱龍、孫光煥、于大雄、張聖原、丁慧恭

國防醫學院三軍總醫院外科部泌尿外科

Initial Experience with En-bloc Thulium Laser Enucleation of the prostate

Yung-Hao Liu, Chi-Wei Tsao, En Meng, Sheng-Tang Wu, Tai-Lung Cha, Guang-Huan Sun,

Dah-Shyong Yu, Sun-Yran Chang, Hui-Kung Ting

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Purpose: Laser enucleation of the prostate using thulium laser (ThuLEP) is a safe and effective treatment for benign prostatic hyperplasia (BPH). Technical execution has evolved from the standard three-lobes to the more recent en-bloc approaches. The aim of this paper is to describe the initial experience of such modified enucleation technique (en-bloc ThuLEP).

Materials and Methods: A retrospective study was done on 130 patients who had ThuLEP between September 2021 and December 2023 by a single surgeon. Prostate-specific antigen (PSA) drop, pre-operative prostate sizes, enucleated prostate volume were collated. Also, enucleation and morcellation efficiency were analyzed. The 130 patients were divided into Group A (1st 50 patients) and Group B (the following 80 patients), and these two groups were compared to each other.

Results: The major significant differences between Groups A and B related to the enucleation and morcellation time and efficiency (Enucleation efficiency- Group A: 0.50 ± 0.20; Group B: 0.56 ± 0.23g/min, p=0.03. Morcellation efficiency- Group A: 3.41 ± 1.43; Group B: 4.53 ± 2.45g/min, p<0.001). Skill improvement was continuous but tended to stabilize with case accumulation. The main short-term complications observed in the hospital and 30 days post-operatively included acute urinary retention, urinary tract infection, transient incontinence, and gross hematuria.

Conclusions: The en bloc ThuLEP provided a significantly improved voiding with low complications and recurrence, and this technique could feasibly be adopted and improved by beginners.