Transurethral plasmakinetic bipolar enucleation of the prostate and diode laser enucleation of the prostate in day surgery patients / 中华泌尿外科杂志

ABSTRACT

Objective:To compare the clinical safety and the efficacy of the transurethral plasmakinetic bipolar enucleation of the prostate and diode laser enucleation of the prostate in day surgery patients.Methods:The clinical data of 99 patients with benign prostatic hyperplasia (BPH) who underwent day surgery in Zhujiang Hospital of Southern Medical University from August 2019 to August 2021 were retrospectively analyzed. Among them, 47 cases underwent transurethral plasmakinetic bipolar enucleation of the prostate (bipolar group), and 52 cases were treated with diode laser enucleation of the prostate (diode laser group). There were no significant differences in age [57.0(56.0, 61.0)years old vs. 59.0(57.0, 62.0)years old], prostate volume[(60.0±8.2)ml vs. (57.4±9.4)ml], preoperative total prostate-specific antigen (tPSA) [(1.8±0.9) ng/ml and (2.2±0.9) ng/ml], postvoid residual (PVR) [20.0(0, 40.0)ml vs. 20.0(1.3, 41.5)ml], maximum flow rate (Q max) [(9.4±2.6) ml/s vs. (9.6±1.9) ml/s], International Prostate Symptom Score (IPSS) [19.0(16.0, 21.0) vs. 19.0(18.0, 21.0)], quality of life (QOL) [5.0(4.0, 5.0)vs. 5.0(4.0, 5.0)] and International Index of Erectile Function 5 (IIEF-5) [(18.8±1.0) vs. (19.2±0.9)] score between the bipolar group and diode laser group (all P>0.05). The indexes of operation time, postoperative hemoglobin decline, blood sodium decline, bladder irrigation time, catheter indwelling time, Q max, IPSS, QOL, IIEF-5 score and so on were compared between the two groups. Results:All day surgeries were successfully completed without serious complications. The operation time of the bipolar group was less than that of the diode laser group [(57.3 ± 4.2) vs. (64.4 ± 6.3) min, P<0.001], and no statistically significant difference was found in the postoperative hemoglobin decline between the two groups [(9.8 ± 4.3) g/L vs. (8.5 ± 4.3) g/L, P=0.154]. None of the patients received transfusion treatment, and neither group of patients had severe hematuria or needed to be readmitted to hospital. There was no significant difference in the decrease of blood sodium [1.7 (1.3, 2.0) mmol/L vs. 1.7 (1.5, 1.9) mmol/L] and the postoperative bladder irrigation time [(7.7 ± 1.4)h vs. (8.0 ± 1.6)h] between the bipolar and diode laser groups ( P > 0.05). There were 8 patients in the bipolar group and 7 patients in the diode laser group who retained urinary catheter for 48-60 h due to intraoperative inflammatory changes in the prostate, and the remaining patients had their urinary catheter removed within 24 hours. The Q max of the bipolar group and the diode laser group one month after surgery were (20.4 ± 1.8) and (21.1 ± 1.7) ml/s, IPSS scores were 7.0 (7.0, 8.0) and 7.0 (7.0, 8.0), and QOL scores were 3.0 (3.0, 3.0) and 3.0 (2.0, 3.0), respectively. There were no significant differences in Q max, IPSS and QOL between the two groups (all P > 0.05). Conclusions:Transurethral plasmakinetic bipolar enucleation of the prostate is also feasible for day surgery, and the short-term postoperative Q max, IPSS, hemoglobin reduction and other indicators have no significant difference compared with diode laser enucleation of the prostate, and can achieve the same efficacy and safety as diode laser enucleation of prostate.