保留功能尿道钬激光前列腺剜除术降低术后尿失禁的优势探讨.

Objective To evaluate the occurrence of stress urinary incontinence after functional urethra sparing HoLEP (Fus-HoLEP) and its clinical value. Methods Clinical data of 776 patients who underwent HoLEP from June 2017 to December 2019 were retrospectively analyzed. The patients were divided into two groups. The patients in group A received "partial urethral mucosa preservation" technique, and the patients group B received "functional urethral preservation" technique. The intraoperative and postoperative parameters were recorded. The status of urinary incontinence and symptoms after micturition were evaluated according to the international recommended standards for urinary incontinence. Results The average ages of the two groups were 75±7.23 (62~91) years old and 76±7.12 (60~88)years old, the prostate volumes were 110±45.5 (48 ~ 160ml) and 108±47.8 (50 ~ 172ml), the enucleation times were 35±10.3min and 36±12.4min, the enucleation speeds were 3.2±0.24g/min and 3.4±0.28g/min. All patients were extubated within 24 hours, and the incidence of stress urinary incontinence immediately after extubation was 30.5% in group A and 13.2% in group B, which was significantly lower than that in group A. Two weeks after operation, the incidence of stress urinary incontinence was 1.6% in group B, which was significantly lower than 18.4% in group A. One month after operation, the incidence of urinary incontinence was 5.4% in group A and 0.7% in group B, which was significantly lower than that in group A. There were no significant differences in IPSS, QOL, Qmax and PVR between the two groups. In group A, urinary retention occurred in 7 patients after extubation, including 4 cases of blood clogging. In group B, urinary retention occurred in 4 patients after extubation, including 2 cases of blood clogging, and all catheters removal 3 days later after repeated catheterization and bladder irrigation. All patients had no severe bleeding and blood transfusion. Conclusion Holmium laser enucleation of prostate with functional urethra preservation can significantly reduce the incidence of urinary incontinence after operation, which is worthy of promotion. [ABSTRACT FROM AUTHOR]