Transurethral diode laser enucleation versus transurethral electrovaporization resection of the prostate for benign prostatic hyperplasia with different prostate volumes

LIU Duo; FAN Li; LIU Cheng; LIU Xue-jun; ZHU Dong-sheng; MU Jia-gui; YAO Dong-wei; SONG Qun

doi:10.13263/j.cnki.nja.2017.03.005

Abstract：Objective:To compare the clinical effect of diode laser enucleation of the prostate (DIOD) with that of transurethral resection of the prostate (TURP) on benign prostate hyperplasia (BPH) with different prostate volumes.Methods:This retrospective study included 256 BPH patients treated by DIOD (n =141) or TURP (n =115) from March 2012 to August 2015.According to the prostate volume,we divided the patients into three groups:＜60 ml (42 for DIOD and 31 for TURP),60-80 ml (51 for DIOD and 45 for TURP),and ＞80 ml (48 for DIOD and 39 for TURP).We obtained the relevant data from the patients before,during and at 6 months after surgery,and compared the two surgical strategies in operation time,perioperative levels of hemoglobin and sodium ion,post-operative urethral catheterization time and bladder irrigation time,pre-and post-operative serum PSA levels,International Prostate Symptoms Score (IPSS),post-void residual urine (PVR) volume and maximum urinary flow rate (Qmax),and incidence of post-operative complications among different groups.Results:In the ＜ 60 ml group,there were no remarkable differences in the peri-and post-operative parameters between the two surgical strategies.In the 60-80 ml group,DIOD exhibited a significant superiority over TURP in the perioperative levels of hemoglobin ([3.25 ± 1.53] g/L vs [4.77 ± 1.67] g/L,P ＜ 0.05) and Na + ([3.58 ± 1.27]mmol/Lvs [9.67 ± 2.67] mmol/L,P ＜0.01),bladder irrigation time ([30.06 ± 6.22]hvs [58.32 ± 10.25] h,P ＜0.01),and urethral catheterization time ([47.61 ± 13.55] hvs [68.01 ± 9.69] h,P ＜0.01),but a more significant decline than the latter in the postoperative PSA level ([2.34 ± 1.29] ng/ml vs [1.09 ± 0.72] ng/ml,P ＜ 0.05),and similar decline was also seen in the ＞ 80 ml group ([3.35 ± 1.39] ng/ml vs [1.76 ± 0.91] ng/ml,P ＜ 0.05).No blood transfusion was necessitated and nor postoperative transurethral resection syndrome or urethral stricture observed in DIOD.However,the incidence rate of postoperative pseudo-urinary incontinence was significantly higher in the DIOD (22.7％,32/141) than in the TURP group (7.83％,9/115) (P ＜ 0.05).Conclusion:DIOD,with its obvious advantages of less blood loss,higher safety,faster recovery,and more definite short-term effectiveness,is better than TURP in the treatment of BPH with medium or large prostate volume and similar to the latter with small prostate volume.