Endoscopic Prostatic Enucleation in the Treatment of Benign Prostatic Hyperplasia. Initial results of the learning curve
DOI:
https://doi.org/10.54212/27068048.v6i1.69Keywords:
Endoscopic Prostatic Enucleation, Benign prostatic hyperplasia, Treatment. Holium laserAbstract
Objective: Endoscopic Prostatic Enucleation is a new option with good results in the surgical treatment of Benign Prostatic Hyperplasia that produces urinary obstructive symptoms. However, it presents a learning curve that requires several cases with associated complications. In this study we present the results of the first patients to whom this technique was performed.
Material and Methods: We evaluated the files of 15 patients who underwent Endoscopic Prostate Enucleation in a period of 6 months using Holium Laser. Prostate weight prior to the procedure, surgical time, time of use of Foley catheter, decrease in grams of Hemoglobin after surgery, and trans operative and post-operative complications were determined. Statistical analysis was performed with linear correlation of variables such as prostate volume / surgical time, prostate volume / Foley catheter time and prostate volume / hemoglobin change.
Results: Information was collected from 15 patients, one of which was converted to bipolar transurethral resection from the beginning due to technical difficulty. The average weight of the prostates was 95.57 gr., With a change of hemoglobin on average of 2.85 g / dl, a hospital time of 1.89 days, a surgical time of 240 minutes and a probe time of 4.93 days. An operating efficiency of 0.398 gr / min was obtained. There were 5 transoperative complications, 3 bladder mucosal lesions and 2 capsule perforations. A urethral stricture developed in one patient and urgency incontinence developed in 2 patients. There is a correlation between prostatic volume / surgical time, prostatic volume / time of probe and prostatic volume / change of hemoglobin.
Conclusions Endoscopic prostatic Enucleation with Holium laser is an effective technique with adequate long-term results. However, a learning curve is necessary between 20 to 40 procedures depending on whether there is supervision. It is not free of complications so it is recommended to start the learning curve in patients with prostate under 80 grams and perform transrectal ultrasound to determine the anatomical complexity.
La Hiperplasia Prostática Benigna (HPB) es una de las patologías mas frecuentes en hombres por arriba de los 50 años, especialmente en poblaciones donde la esperanza de vida supera los 70 años en promedio. La Resección Transuretral de próstata ( RTUP) se ha considerado el gold estándar en el tratamiento quirúrgico de la HPB (1). Sin embargo, no esta exenta de complicaciones y, sobre todo en próstatas con pesos mayores a 100 gramos. Hasta un 15% de pacientes requieren de re intervención en los siguientes 10 años (2). Por lo anterior, se ha recomendado que la RTUP es el procedimiento quirúrgico estándar en pacientes con síntomas urinarios obstructivos causados por próstatas entre 30 a 80 gramos (3). Para las próstatas obstructivas con volúmenes mayores se optaba por la cirugía abierta. En 1998 Peter Gilling y R. Fraundorfer describieron la enucleación prostática endoscópica con láser Holmium (4). Desde entonces, resultados de estudios basados en la evidencia han demostrado su seguridad, eficacia y durabilidad en el tratamiento de la HPB (5). Además, se ha convertido en una alternativa costo – efectiva en países en desarrollo (6). Sin embargo, las dificultades en el aprendizaje y los costos en equipamiento ha evitado que sea adoptado por todos los urólogos llegando inclusive a ser abandonado su implementación en algunos centros por las complicaciones encontradas en el inicio de la curva de aprendizaje (7).
En este estudio describimos los resultados obtenidos en los primeros casos realizados en pacientes con Hiperplasia Prostática Benigna para poder identificar las complicaciones mas frecuentemente presentadas al realizar dichas cirugías con auto enseñanza.
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