神戸市立中央市民病院におけるHoLEPの臨床的検討

Abstract

下部尿路症状を有する前立腺肥大症患者43例にホルミウムレーザー前立腺核出術(HoLEP)を行い、治療成績および安全性について検討した。平均手術時間193分、平均切除重量40.2g、術前後平均ヘモグロビン減少量2.1g/dlで、尿道カテーテル留置期間は平均1.7日、術後入院期間は平均5.5日であった。合併症は、術中に前立腺被膜損傷8例、Morcellation膀胱粘膜損傷10例を認め、術前に貧血を有した1例に輸血を要した。術後は、入院中の合併症として38度以上の発熱を6例に認め、うち1例に敗血症を認めたが抗生剤点滴にて改善した。また、退院時に尿失禁を22例に認めた。退院後合併症は外尿道狭窄を7例認め、うち3例に外尿道口形成術を行った。球部尿道狭窄は3例認めた。更に、1例で急性精巣上体炎を来たし、陰嚢内膿瘍となったため切開排膿を要した。投薬あるいは1日2パッド以上を必要とする、腹圧性が主体の尿失禁を術後1ヵ月以上で12例、3ヵ月以上で4例認めた。平均最大尿流量は術後有意に改善し、平均残尿量、IPSSおよびQOLスコアも術後有意に改善した。

Between October 2004 and August 2005, 43 patients with the mean age of 70.9 (ranging 57-83) years, who had lower urinary tract symptoms underwent holmium laser enucleation of the prostate (HoLEP) at our hospital. The mean operative time, change in hemoglobin and resected tissue weight were 193 (83-390) minutes, -2.1 (-5.3 -/+ 1.3) g/dl and 40.2 (6.3-90.9) g, respectively. The mean postoperative urethral catheter time and postoperative hospital stay were 1.7 and 5.5 days, respectively. Minor prostatic capsular perforation and bladder mucosal injuries in 18 cases without need of additional interventions or treatments. Blood transfusion for preoperative anemia was needed in one case. Postoperatively, high fever occurred in 6 cases including sepsis in one case, while recatheterization was needed in 2 cases because of urination difficulty. After discharge, meatal stenosis was found in 7 cases, urethral stenosis in 3 cases including 2 cases with preoperative urethral stenosis. Scrotal abscess developed after acute epididymitis in one case. Transient urinary incontinence reported in 12 cases, which requires medication or more than 1 pad per day. HoLEP improved international prostate symptom score, quality of life score, peak urinary flow rates and postvoiding residual urine volumes immediately and significantly. HoLEP is a feasible and effective procedure to relieve lower urinary tract symptoms, although technical and instrumental advances are required to reduce the operative time and complications.