前立腺肥大症（80g超）に対するホルミウムYAGレーザーとバイポーラ前立腺摘除術の管理：多施設共同前向き無作為化比較試験
H Shaker1, A Yehia2, M El Adawy1
1Urology Department, Fayoum University, Egypt.
Objectives:
Endoscopic enucleation of the prostate (EEP) was introduced to treat patients with large prostate. The study compared the perioperative and post-operative outcomes of bipolar current and Thulium-YAG in endoscopic enucleation of large prostates above 80 gm.
Patients And Methods:
This is a prospective study conducted on 120 male patients. The patients were randomized into two equal groups; Group A Thulium laser enucleation of the prostate (THuLEP) and Group B bipolar enucleation of the prostate (BEEP). All patients were preoperatively evaluated as regards operative time, hemoglobin drop, intraoperative and early postoperative complications, hospital stay, and time of catheter removal. Patients were then followed up at 1, 3, 6, and 12 months to detect urinary and sexual functional outcome and any postoperative complications.
Results:
The preoperative characteristics of both groups were comparable. The mean prostate volume was 122.33 ± 24.34 (84-180 gms) and 120.88 ± 25.66 (85-180gms) (p value: 0.751) in THuLEP and bipolar groups, respectively. Significant comparable improvement in IPSS score, Q max, and PVR postoperatively was found in both groups at all follow up points. Follow up after 1 month revealed urgency urinary incontinence in 34 (56.7%) cases in THuLEP and 14 (23.3%) cases in bipolar enucleation group (p value 0.001), and stress urinary incontinence was detected in 44 (73.3%) cases in THuLEP and 26 (43.3%) cases in bipolar enucleation group, respectively (p value 0.001). Both types of incontinence improved after 3 months in both groups, three cases in the THuLEP group had persistent stress incontinence after 1 year.
Conclusion:
ThuLEP and bipolar enucleation are comparable treatment modalities for patients with large prostate (>80 ml).
