Андрология и генитальная хирургия. 2017; 18: 83-88
ЭНДОСКОПИЧЕСКАЯ ЭНУКЛЕАЦИЯ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ – НОВЫЙ СТАНДАРТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ГИПЕРПЛАЗИИ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ
https://doi.org/10.17650/2070-9781-2017-18-3-83-88Аннотация
В последних рекомендациях Европейской ассоциации урологов (2016) по лечению симптомов со стороны нижних мочевыводящих путей, вызванных гиперплазией предстательной железы (ПЖ), описан новый термин – endoscopic enucleation of the prostate (эндоскопическая энуклеация ПЖ). Своим появлением этот термин обязан данным последних метаанализов, доказавших, что как лазерная энуклеация, так и электроэнуклеация являются эффективными методиками лечения инфравезикальной обструкции, вызванной гиперплазией ПЖ.
Цель исследования – сравнить методы электроэнуклеации и лазерных энуклеаций (тулиевая, гольмиевая) гиперплазии ПЖ по данным литературных источников и собственным наблюдениям.
Материалы и методы. В исследовании приняли участие 624 пациента с доброкачественной гиперплазией ПЖ; из них 459 пациентов перенесли гольмиевую энуклеацию (holmium laser enucleation of the prostate, HoLEP), 35 – монополярную энуклеацию, 130 – тулиевую энуклеацию (thulium laser enucleation of the prostate, ThuLEP). Срок наблюдения за всеми пациентами составил 1 мес. Нами была проведена оценка показателя по опроснику IPSS (International Prostate Symptom Score), индекса качества жизни (QoL), максимальной объемной скорости потока мочи (Qmax) и объема остаточной мочи перед операцией и через месяц после нее.
Результаты. Функциональные результаты через 1 мес после операции во всех 3 группах показали значимое улучшение. Более того, полученные данные указывают на одинаковую сравнительную эффективность методов эндоскопической энуклеации. Не было выявлено статистически значимого отклонения ни по одному из исследуемых параметров (p >0,05).
Выводы. Данные наших практических работ по HoLEP и ThuLEP указывают на высокую эффективность этих операций и низкое количество послеоперационных осложнений, что находится в соответствии с данными литературы и рекомендациями Европейской ассоциации урологов. Монополярная энуклеация ПЖ не уступает ThuLEP и HoLEP по эффективности, но уступает по количеству послеоперационных осложнений.
Список литературы
1. Kaplan S.A. Re: EAU Guidelines on the Assessment of Non-Neurogenic Male Lower Urinary Tract Symptoms Including Benign Prostatic Obstruction. J Urol 2016;196(6):1712–4. DOI: 10.1016/j.juro.2016.09.017. PMID: 27845123.
2. Глыбочко П.В., Аляев Ю.Г., Рапопорт Л.М. и др. Гольмиевая лазерная энуклеация гиперплазии предстательной железы: технические аспекты. Андрология и генитальная хирургия 2015;16(4):62–6. [Glybochko P.V., Alyaev Yu.G., Rapoport L.M. et al. Holmium laser enucleation of the prostate hyperplasia: technical aspects. Andrologiya i genital’naya khirurgiya = Andrology and Genital Surgery 2015;16(4):62–6. (In Russ.)]. DOI: 10.17650/2070-9781-2015-16-4-62-66.
3. Hiraoka Y., Lin T., Tsuboi N., Nakagami Y. Transurethral enucleation of benign prostatic hyperplasia. Nihon Ika Daigaku Zasshi 1986;53(2):212–5. PMID: 2423551.
4. Hiraoka Y., Akimoto M. Transurethral enucleation of benign prostatic hyperplasia. J Urol 1989;142(5):1247–50. PMID: 2478727.
5. Цариченко Д.Г., Симбердеев Р.Р., Глыбочко П.В. и др. Трансуретральная монополярная энуклеация доброкачественной гиперплазии предстательной железы. Наш опыт. Урология 2016;(4):20–5. [Tsarichenko D.G., Simberdeev R.R., Glybochko P.V. et al. Monopolar transurethral enucleation of benign prostatic hyperplasia. Our experience. Urologiya = Urology 2016;(4):20–5. (In Russ.)].
6. Gilling P.J., Kennett K., Das A.K. et al. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol 1998;12(5):457–9. DOI: 10.1089/ end.1998.12.457. PMID: 9847070.
7. Tan A.H., Gilling P.J. Holmium laser prostatectomy: current techniques. Urology 2002;60(1):152–6. PMID: 12100945.
8. Tan A.H., Gilling P.J., Kennett K.M. et al. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol 2003;170(4 Pt 1):1270–4. DOI: 10.1097/01.ju.0000086948.55973.00. PMID: 14501739.
9. Westenberg A., Gilling P., Kennett K. et al. Holmium laser resection of the prostate versus transurethral resection of the prostate: results of a randomized trial with 4-year minimum long-term followup. J Urol 2004;172(2):616–9. DOI: 10.1097/01.ju.0000132739.57555.d8. PMID: 15247745.
10. Tooher R., Sutherland P., Costello A. et al. A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia. J Urol 2004;171(5):1773–81. DOI: 10.1097/01.ju.0000113494.03668.6d. PMID: 15076275.
11. Wilson L.C., Gilling P.J., Williams A. et al. A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol 2006;50(3):569–73. DOI: 10.1016/j.eururo.2006.04.002. PMID: 16704894.
12. Gilling P.J., Cass C.B., Cresswell M.D., Fraundorfer M.R. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology 1996;47(1):48–51. PMID: 8560662.
13. Gilling P.J., Fraundorfer M.R. Holmium laser prostatectomy: a technique in evolution. Curr Opin Urol 1998;8(1):11–5. PMID: 17035836.
14. Fraundorfer M.R., Gilling P.J. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 1998;33(1):69–72. PMID: 9471043.
15. Cresswell M.D., Cass C.B., Fraundorfer M.R., Gilling P.J. Holmium:YAG laser resection of the prostate: preliminary experience with the first 400 cases. N Z Med J 1997;110(1039):76–8. PMID: 9137301.
16. Еникеев Д.В., Глыбочко П.В., Аляев Ю.Г. и др. Гольмиевая лазерная энуклеация (HOLEP) при гиперплазии простаты маленьких, больших и гигантских размеров. Практические рекомендации. Опыт более 450 операций. Урология 2016;(4):63–9. [Enikeev D.V., Glybochko P.V., Alyaev Yu.G. et al. Holmium laser enucleation of the prostate (HOLEP) for small, large and giant prostatic hyperplasia. Practical guidelines. Experience of more than 450 surgeries. Urologiya = Urology 2016;(4):63–9. (In Russ.)].
17. Севрюков Ф.А., Сорокин Д.А., Карпухин И.В. и др. Трансуретральная энуклеация предстательной железы (TUEB) – новый метод биполярной эндоскопической хирургии ДГПЖ. Экспериментальная и клиническая урология 2012;(2):34–6. [Sevryukov F.A., Sorokin D.A., Karpukhin I.V. et al. Transurethral enucleation of the prostate (TUEB) – new option in bipolar endoscopic surgery of BPH. Eksperimental’naya i klinicheskaya urologiya = Experimental and Clinical Urology 2012;(2):34–6. (In Russ.)].
18. da Silva R.D., Bidikov L., Michaels W. et al. Bipolar energy in the treatment of benign prostatic hyperplasia: a current systematic review of the literature. Can J Urol 2015;22 Suppl 1:30–44. PMID: 26497342.
19. Kahokehr A.A., Gilling P.J. Which laser works best for benign prostatic hyperplasia? Curr Urol Rep 2013;14(6):614–9. DOI: 10.1007/s11934-013-0351-8. PMID: 23780301.
20. Herrmann T.R., Liatsikos E.N., Nagele U. et al. European Association of Urology guidelines on laser technologies. Actas Urol Esp 2013;37(2):63–78. DOI: 10.1016/j.acuro.2012.05.005. PMID: 22989380.
21. Kyriazis I., Swiniarski P.P., Jutzi S. et al. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement. World J Urol 2015;33(4):525–30. DOI: 10.1007/s00345-015-1529-0. PMID: 25774004.
22. Netsch C., Bach T., Herrmann T.R. et al. Evaluation of the learning curve for Thulium VapoEnucleation of the prostate (ThuVEP) using a mentor-based approach. World J Urol 2013;31(5):1231–8. DOI: 10.1007/s00345-012-0894-1. PMID: 22733237.
23. Bach T., Muschter R., Sroka R. et al. Laser treatment of benign prostatic obstruction: basics and physical differences. Eur Urol 2012;61(2):317–25. DOI: 10.1016/j.eururo.2011.10.009. PMID: 22033173.
24. Herrmann T.R., Liatsikos E.N., Nagele U. et al. EAU guidelines on laser technologies. Eur Urol 2012;61(4):783–95. DOI: 10.1016/j.eururo.2012.01.010. PMID: 22285403.
25. Herrmann T. R. Enucleation is enucleation is enucleation is enucleation. World J Urol 2016;34(10):1353–5. DOI: 10.1007/s00345-016-1922-3. PMID: 27585786.
26. Li M., Qiu J., Hou Q. et al. Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One 2015;10(3):e0121265. DOI: 10.1371/journal.pone.0121265. PMID: 25826453.
27. Netsch C., Bach T., Herrmann T.R., Gross A.J. Update on the current evidence for Tm:YAG vapoenucleation of the prostate 2014. World J Urol 2015;33(4):517– 24. DOI: 10.1007/s00345-014-1417-z. PMID: 25300823.
28. Netsch C., Engbert A., Bach T., Gross A.J. Long-term outcome following Thulium VapoEnucleation of the prostate. World J Urol 2014;32(6):1551–8. DOI: 10.1007/s00345-014-1260-2. PMID: 24531878.
29. Tiburtius C., Gross A.J., Netsch C. A prospective, randomized comparison of a 1940 nm and a 2013 nm thulium: yttrium-aluminum-garnet laser device for Thulium VapoEnucleation of the prostate (ThuVEP): First results. Indian J Urol 2015;31(1):47–51. DOI: 10.4103/0970-1591.148308. PMID: 25624576.
30. Hong K., Liu Y.Q., Lu J. et al. Efficacy and safety of 120-W thulium:yttrium-aluminum-garnet vapoenucleation of prostates compared with holmium laser enucleation of prostates for benign prostatic hyperplasia. Chin Med J (Engl) 2015;128(7):884–9. DOI: 10.4103/0366-6999.154282. PMID: 25836607.
Andrology and Genital Surgery. 2017; 18: 83-88
ENDOSCOPIC ENUCLEATION OF THE PROSTATE – A NEW STANDARD IN SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA
https://doi.org/10.17650/2070-9781-2017-18-3-83-88Abstract
The latest guideline of the European Association of Urology (2016) for the management of lower urinary tract symptoms has a new term – endoscopic enucleation of the prostate. This term was introduced after the publication of latest meta-analyses showing that both laser enucleation and electroenucleation are effective in the treatment of infravesical obstruction caused by benign prostatic hyperplasia (BPH).
Objective: to compare the methods of electroenucleation and laser enucleation (holmium and thulium) of the prostate according to the literature data and own observations.
Materials and methods. A total of 624 patients with BPH were included in the study; of them, 459 participants underwent holmium laser enucleation (HoLEP), 35 – monopolar enucleation, and 130 – thulium laser enucleation (ThuLEP). All patients were followed up for one month. We assessed the International Prostate Symptom Score (IPSS), patients’ quality of life (QoL), peak flow rate (Qmax), and residual urine volume prior to surgery and 1 month after it.
Results. Functional characteristics have significantly improved by one month post surgery in all three groups. Moreover, the data obtained indicate similar efficacy of different endoscopic enucleation methods. None of the tested parameters demonstrated significant difference across the groups (p >0.05)
Conclusions. Our results of HoLEP and ThuLEP suggest high efficacy of these surgical techniques and low number of postoperative complications, which correlates with literature data and guidelines of the European Association of Urology. Monopolar enucleation of the prostate is as effective as ThuLEP or HoLEP; however it has higher frequency of postoperative complications.
References
1. Kaplan S.A. Re: EAU Guidelines on the Assessment of Non-Neurogenic Male Lower Urinary Tract Symptoms Including Benign Prostatic Obstruction. J Urol 2016;196(6):1712–4. DOI: 10.1016/j.juro.2016.09.017. PMID: 27845123.
2. Glybochko P.V., Alyaev Yu.G., Rapoport L.M. i dr. Gol'mievaya lazernaya enukleatsiya giperplazii predstatel'noi zhelezy: tekhnicheskie aspekty. Andrologiya i genital'naya khirurgiya 2015;16(4):62–6. [Glybochko P.V., Alyaev Yu.G., Rapoport L.M. et al. Holmium laser enucleation of the prostate hyperplasia: technical aspects. Andrologiya i genital’naya khirurgiya = Andrology and Genital Surgery 2015;16(4):62–6. (In Russ.)]. DOI: 10.17650/2070-9781-2015-16-4-62-66.
3. Hiraoka Y., Lin T., Tsuboi N., Nakagami Y. Transurethral enucleation of benign prostatic hyperplasia. Nihon Ika Daigaku Zasshi 1986;53(2):212–5. PMID: 2423551.
4. Hiraoka Y., Akimoto M. Transurethral enucleation of benign prostatic hyperplasia. J Urol 1989;142(5):1247–50. PMID: 2478727.
5. Tsarichenko D.G., Simberdeev R.R., Glybochko P.V. i dr. Transuretral'naya monopolyarnaya enukleatsiya dobrokachestvennoi giperplazii predstatel'noi zhelezy. Nash opyt. Urologiya 2016;(4):20–5. [Tsarichenko D.G., Simberdeev R.R., Glybochko P.V. et al. Monopolar transurethral enucleation of benign prostatic hyperplasia. Our experience. Urologiya = Urology 2016;(4):20–5. (In Russ.)].
6. Gilling P.J., Kennett K., Das A.K. et al. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol 1998;12(5):457–9. DOI: 10.1089/ end.1998.12.457. PMID: 9847070.
7. Tan A.H., Gilling P.J. Holmium laser prostatectomy: current techniques. Urology 2002;60(1):152–6. PMID: 12100945.
8. Tan A.H., Gilling P.J., Kennett K.M. et al. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol 2003;170(4 Pt 1):1270–4. DOI: 10.1097/01.ju.0000086948.55973.00. PMID: 14501739.
9. Westenberg A., Gilling P., Kennett K. et al. Holmium laser resection of the prostate versus transurethral resection of the prostate: results of a randomized trial with 4-year minimum long-term followup. J Urol 2004;172(2):616–9. DOI: 10.1097/01.ju.0000132739.57555.d8. PMID: 15247745.
10. Tooher R., Sutherland P., Costello A. et al. A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia. J Urol 2004;171(5):1773–81. DOI: 10.1097/01.ju.0000113494.03668.6d. PMID: 15076275.
11. Wilson L.C., Gilling P.J., Williams A. et al. A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol 2006;50(3):569–73. DOI: 10.1016/j.eururo.2006.04.002. PMID: 16704894.
12. Gilling P.J., Cass C.B., Cresswell M.D., Fraundorfer M.R. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology 1996;47(1):48–51. PMID: 8560662.
13. Gilling P.J., Fraundorfer M.R. Holmium laser prostatectomy: a technique in evolution. Curr Opin Urol 1998;8(1):11–5. PMID: 17035836.
14. Fraundorfer M.R., Gilling P.J. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 1998;33(1):69–72. PMID: 9471043.
15. Cresswell M.D., Cass C.B., Fraundorfer M.R., Gilling P.J. Holmium:YAG laser resection of the prostate: preliminary experience with the first 400 cases. N Z Med J 1997;110(1039):76–8. PMID: 9137301.
16. Enikeev D.V., Glybochko P.V., Alyaev Yu.G. i dr. Gol'mievaya lazernaya enukleatsiya (HOLEP) pri giperplazii prostaty malen'kikh, bol'shikh i gigantskikh razmerov. Prakticheskie rekomendatsii. Opyt bolee 450 operatsii. Urologiya 2016;(4):63–9. [Enikeev D.V., Glybochko P.V., Alyaev Yu.G. et al. Holmium laser enucleation of the prostate (HOLEP) for small, large and giant prostatic hyperplasia. Practical guidelines. Experience of more than 450 surgeries. Urologiya = Urology 2016;(4):63–9. (In Russ.)].
17. Sevryukov F.A., Sorokin D.A., Karpukhin I.V. i dr. Transuretral'naya enukleatsiya predstatel'noi zhelezy (TUEB) – novyi metod bipolyarnoi endoskopicheskoi khirurgii DGPZh. Eksperimental'naya i klinicheskaya urologiya 2012;(2):34–6. [Sevryukov F.A., Sorokin D.A., Karpukhin I.V. et al. Transurethral enucleation of the prostate (TUEB) – new option in bipolar endoscopic surgery of BPH. Eksperimental’naya i klinicheskaya urologiya = Experimental and Clinical Urology 2012;(2):34–6. (In Russ.)].
18. da Silva R.D., Bidikov L., Michaels W. et al. Bipolar energy in the treatment of benign prostatic hyperplasia: a current systematic review of the literature. Can J Urol 2015;22 Suppl 1:30–44. PMID: 26497342.
19. Kahokehr A.A., Gilling P.J. Which laser works best for benign prostatic hyperplasia? Curr Urol Rep 2013;14(6):614–9. DOI: 10.1007/s11934-013-0351-8. PMID: 23780301.
20. Herrmann T.R., Liatsikos E.N., Nagele U. et al. European Association of Urology guidelines on laser technologies. Actas Urol Esp 2013;37(2):63–78. DOI: 10.1016/j.acuro.2012.05.005. PMID: 22989380.
21. Kyriazis I., Swiniarski P.P., Jutzi S. et al. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement. World J Urol 2015;33(4):525–30. DOI: 10.1007/s00345-015-1529-0. PMID: 25774004.
22. Netsch C., Bach T., Herrmann T.R. et al. Evaluation of the learning curve for Thulium VapoEnucleation of the prostate (ThuVEP) using a mentor-based approach. World J Urol 2013;31(5):1231–8. DOI: 10.1007/s00345-012-0894-1. PMID: 22733237.
23. Bach T., Muschter R., Sroka R. et al. Laser treatment of benign prostatic obstruction: basics and physical differences. Eur Urol 2012;61(2):317–25. DOI: 10.1016/j.eururo.2011.10.009. PMID: 22033173.
24. Herrmann T.R., Liatsikos E.N., Nagele U. et al. EAU guidelines on laser technologies. Eur Urol 2012;61(4):783–95. DOI: 10.1016/j.eururo.2012.01.010. PMID: 22285403.
25. Herrmann T. R. Enucleation is enucleation is enucleation is enucleation. World J Urol 2016;34(10):1353–5. DOI: 10.1007/s00345-016-1922-3. PMID: 27585786.
26. Li M., Qiu J., Hou Q. et al. Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One 2015;10(3):e0121265. DOI: 10.1371/journal.pone.0121265. PMID: 25826453.
27. Netsch C., Bach T., Herrmann T.R., Gross A.J. Update on the current evidence for Tm:YAG vapoenucleation of the prostate 2014. World J Urol 2015;33(4):517– 24. DOI: 10.1007/s00345-014-1417-z. PMID: 25300823.
28. Netsch C., Engbert A., Bach T., Gross A.J. Long-term outcome following Thulium VapoEnucleation of the prostate. World J Urol 2014;32(6):1551–8. DOI: 10.1007/s00345-014-1260-2. PMID: 24531878.
29. Tiburtius C., Gross A.J., Netsch C. A prospective, randomized comparison of a 1940 nm and a 2013 nm thulium: yttrium-aluminum-garnet laser device for Thulium VapoEnucleation of the prostate (ThuVEP): First results. Indian J Urol 2015;31(1):47–51. DOI: 10.4103/0970-1591.148308. PMID: 25624576.
30. Hong K., Liu Y.Q., Lu J. et al. Efficacy and safety of 120-W thulium:yttrium-aluminum-garnet vapoenucleation of prostates compared with holmium laser enucleation of prostates for benign prostatic hyperplasia. Chin Med J (Engl) 2015;128(7):884–9. DOI: 10.4103/0366-6999.154282. PMID: 25836607.
