Lebensqualität und Outcome nach Holmiumlaserenukleation der Prostata (HoLEP)

Zusammenfassung

Hintergrund Die Holmium-Laser-Enukleation der Prostata(HoLEP) wurde vor gut 20 Jahren als wirksame Alternative zur transurethralen Resektion der Prostata(TURP) eingeführt mit vorteilhafterem Nebenwirkungsprofil. Die HoLEP kann unabhängig von der Prostatagröße angewendet werden und wird seitens urologischen Leitlinien für die chirurgische Behandlung der benignen Prostata Hyperplasie (BPH) empfohlen. Dennoch äußern Patienten gegenüber transurethralen Desobstruktionen oft Misstrauen und Ängste in Bezug auf Schmerzen und potentielle Komplikationen. Das Ziel dieser Arbeit war es, auf Basis von „Patient-reported Outcome Measures“ (PROMs) mittels Fragebögen, die Zufriedenheit anhand der Empfindungen der Patienten zu evaluieren.

Material und Methoden In der Zeit von Juni bis einschließlich Dezember 2020 wurden 152 Patienten mittels HoLEP aufgrund einer subvesikalen Obstruktion operiert und mittels Fragebögen unmittelbar postoperativ und 3 Monate später bezüglich Ihrer Behandlungs-Zufriedenheit und ihrer Miktionsfunktion und Kontinenz befragt. Es wurden 112 Patienten in die Studie eingeschlossen. Das 3 Monats-Follow-up konnte für 88 dieser Patienten in die retrospektive Analyse aufgenommen werden.

Ergebnisse Es wurden durchschnittlich 62,1 [g] Adenomgewebe enukleiert bei einem durchschnittlichen präoperativ transrekalem Ultraschall(TRUS)-Volumen von 83,1 [cm3]. In 45,4% der Patienten lag bereits präoperativ ein transurethraler Dauerkatheter ein. Es zeigte sich eine Gesamtzufriedenheit mit der OP und dem Aufenthalt in der Klinik postoperativ bei 94,6% und nach drei Monaten bei 91,8%. Der Anteil der mit der Miktion zufriedenen Patienten betrug postoperativ 76,5% und steigerte sich auf 80,4% nach 3 Monaten. Der Anteil der Patienten, die Kontinenzbeschwerden angaben, lag initial bei 8,3% dann 3 Monate später bei 9,1%. Bei der Frage nach dem Lebensqualitätsindex [L] verbesserten sich die positiven Antworten von 62,1% postoperativ auf 85,7% nach 3 Monaten. Der Anteil der Patienten mit negativen Antworten reduzierte sich von 11,7% auf 3,4%.

Diskussion Die HoLEP ist ein etabliertes und sicheres Verfahren zur operativen Therapie der BPH. Um auf die bestehenden Vorbehalte bei Patienten eingehen zu können, ist eine Befragung der subjektiven Zufriedenheit von operierten Patienten nach dem Eingriff und im zeitlichen Verlauf wichtig. Die festgestellte hohe Patientenzufriedenheit könnte sowohl betroffene Patienten als auch niedergelassene Kolleg*Innen motivieren, möglichst frühzeitig eine operative Intervention zu erwägen.

Abstract

Background Holmium Laser Enucleation of the Prostate (HoLEP) was established 20 years ago as an alternative to Transurethral Resection of the Prostate (TUR-P) based on improved morbidity in patients with benign prostate syndrome (BPS). HoLEP can be applied independently to almost all sizes of prostate glands and is recommended in national and international guidelines. Although the HoLEP procedure has a good reputation, many patients still prefer conservative treatment due to fears of side-effects such as pain and urinary incontinence. The aim of this study was to identify patients’ feelings, fears and perception of their HoLEP treatment based on Patient-reported Outcome Measures (PROMs) via questionnaires.

Material und Methods During the time period from June to December 2020, 152 consecutive patients were treated by HoLEP due to BPS and were interviewed based on questionnaires right after their surgical treatment and 3 months later concerning their satisfaction as well as micturition and continence. Based on a written informed consent, 112 patients were included in the study, and a complete 3-month follow-up was available for 88 patients.

Results The mean volume of enucleated prostate tissue was 62.1 [g] and the mean prostate volume estimated pre-operatively (trans-rectal ultrasound) was 83.1 [cm3]. Overall patient-reported satisfaction with the hospital stay including surgical treatment was 94.6%; after 3 months it was 91.8%. Concerning micturition, 76.5% of the patients reported satisfaction after surgery and 80.4% were satisfied after 3 months. Urinary incontinence was reported in 8.3% initially and in 9.1% after 3 months. Positive answers to questions concerning the quality of life index [L] were obtained in 62.1% initially and their number increased to 85.7% after 3 months. The share of negative answers decreased from 11.7% after surgery to 3.4% within the 3-month follow-up.

Discussion HoLEP is a well-established treatment of BPS with lower side-effects compared with TUR-P according to the literature. To address doubts and misgivings, it is important to perform surveys on subjective patient satisfaction after the surgical procedure and over time. The high patient satisfaction could help future patients and the urologists treating them to establish the indication for HoLEP treatment earlier in order to avoid severe LUTS or catheterization.

Schlüsselwörter

HoLEP - TURP - Lebensqualität - Inkontinenz

Keywords

HoLEP - TURP - Urinary incontinence - quality of life

• Referenzen

• 1 Blom JH, Schroder FH. Epidemiology and natural course of benign prostatic hyperplasia. Der Urologe Ausg A 1992; 31: 129-34
• 2 Roehrborn CG. Benign prostatic hyperplasia: an overview. Reviews in urology 2005; 7: S3-S14
• 3 Schneider AW, Fichtner J. The demographic development in Germany: challenge and chances for urology. Der Urologe Ausg A 2014; 53: 1136-45
• 4 DESTATIS – Statistisches Bundesamt G-S-R, 65189 Wiesbaden. Bevölkerung - Zukünftige Bevölkerungsentwicklung 2022. Available from. Accessed June 09, 2022 at: https://www.destatis.de/DE/Themen/Querschnitt/Demografischer-Wandel/Aspekte/demografie-bevoelkerungsentwicklung.html#:~:text=Die%20Zahl%20der%20Menschen%20im,bis%202060%20relativ%20stabil%20bleiben
• 5 Gul ZG, Kaplan SA. BPH: Why Do Patients Fail Medical Therapy?. Current urology reports 2019; 20: 40
• 6 Hong SJ, Ko WJ, Kim SI. et al. Identification of baseline clinical factors which predict medical treatment failure of benign prostatic hyperplasia: an observational cohort study. European urology 2003; 44: 94
• 7 Dahm P, Brasure M, MacDonald R. et al. Comparative Effectiveness of Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis. European urology 2017; 71: 570-81
• 8 Ahn HS, Kim SJ, Choi JB. et al. Long-term cost comparison between surgical and medical therapy for benign prostatic hyperplasia: a study using hospital billing data. BJU international 2019; 123: E79-E85
• 9 Gudaru K, Gonzalez Padilla DA, Castellani D. et al. A global knowledge, attitudes and practices survey on anatomical endoscopic enucleation of prostate for benign prostatic hyperplasia among urologists. Andrologia 2020; 52: e13717
• 10 Gravas SCJN GM, Gratzke C, Herrmann TRW. et al. Management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Arnhem: EAU Guidelines Office; 2019
• 11 Lerner LB, McVary KT, Barry MJ. et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART I-Initial Work-up and Medical Management. The Journal of urology 2021; 206: 806-17
• 12 Lerner LB, McVary KT, Barry MJ. et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART II-Surgical Evaluation and Treatment. The Journal of urology 2021; 206: 818-26
• 13 Enikeev D, Taratkin M, Morozov A. et al. Long-Term Outcomes of Holmium Laser Enucleation of the Prostate: A 5-Year Single-Center Experience. Journal of endourology 2020; 34: 1055-63
• 14 Fallara G, Capogrosso P, Schifano N. et al. Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate. European urology focus 2021; 7: 612-7
• 15 Ahyai SA, Gilling P, Kaplan SA. et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. European urology 2010; 58: 384-97
• 16 Cornu JN, Ahyai S, Bachmann A. et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. European urology 2015; 67: 1066-96
• 17 Habib E, Ayman LM, ElSheemy MS. et al. Holmium Laser Enucleation vs Bipolar Plasmakinetic Enucleation of a Large Volume Benign Prostatic Hyperplasia: A Randomized Controlled Trial. Journal of endourology 2020; 34: 330-8
• 18 Tamalunas A, Westhofen T, Schott M. et al. The clinical value of holmium laser enucleation of the prostate in octogenarians. Lower urinary tract symptoms 2021; 13: 279-85
• 19 Habib EI, ElSheemy MS, Hossam A. et al. Holmium Laser Enucleation Versus Bipolar Plasmakinetic Resection for Management of Lower Urinary Tract Symptoms in Patients with Large-Volume Benign Prostatic Hyperplasia: Randomized-Controlled Trial. Journal of endourology 2021; 35: 171-9
• 20 Uhlig A, Baunacke M, Groeben C. et al. Contemporary surgical management of benign prostatic obstruction in Germany : A population-wide study based on German hospital quality report data from 2006 to 2019. Der Urologe Ausg A 2022; 61: 508-517
• 21 Loh SY, Chin CM. A demographic profile of patients undergoing transurethral resection of the prostate for benign prostate hyperplasia and presenting in acute urinary retention. BJU international 2002; 89: 531-3
• 22 Chen YT, Hou CP, Juang HH. et al. Comparison of Outcome and Quality of Life Between Thulium Laser (Vela(TM) XL) Enucleation of Prostate and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). Therapeutics and clinical risk management 2022; 18: 145-54
• 23 Anan G, Kaiho Y, Iwamura H. et al. Preoperative pelvic floor muscle exercise for early continence after holmium laser enucleation of the prostate: a randomized controlled study. BMC urology 2020; 20: 3
• 24 Das AK, Teplitsky S, Chandrasekar T. et al. Stress Urinary Incontinence post-Holmium Laser Enucleation of the Prostate: a Single-Surgeon Experience. International braz j urol : official journal of the Brazilian Society of Urology 2020; 46: 624-31
• 25 Liu K, Xiao C, Hao Y. et al. 'Seven-step two-lobe' HoLEP: a modification to gain efficiency of the enucleation applying relatively low-power holmium laser devices. World journal of urology 2021; 39: 2627-33
• 26 Nam JK, Kim HW, Lee DH. et al. Risk Factors for Transient Urinary Incontinence after Holmium Laser Enucleation of the Prostate. The world journal of men's health 2015; 33: 88-94
• 27 Nottingham CU, Agarwal DK, Valadon C. et al. Correlating Patient Anxiety with Urinary Symptoms Before and After Holmium Laser Enucleation of the Prostate. Journal of endourology 2020; 34: 782-7
• 28 Keller IS, Brachlow JF, Padevit C. et al. Urinary incontinence - what can be done by the family doctor and when is the urologist needed?. Praxis 2014; 103: 1181-9
• 29 Tuccio A, Grosso AA, Sessa F. et al. En-Bloc Holmium Laser Enucleation of the Prostate with Early Apical Release: Are We Ready for a New Paradigm?. Journal of endourology 2021; 35: 1675-1683
• 30 Ahyai SA, Marik I, Ludwig TA. et al. Super early detailed assessment of lower urinary tract symptoms after holmium laser enucleation of the prostate (HoLEP): a prospective study. World journal of urology 2020; 38: 3207-17
• 31 Elmansy HM, Elzayat E, Elhilali MM. Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: long-term results of a randomized trial. The Journal of urology 2010; 184: 2023-8
• 32 Vincent MW, Gilling PJ. HoLEP has come of age. World journal of urology 2015; 33: 487-93
• 33 Das AK, Teplitsky S, Humphreys MR. Holmium laser enucleation of the prostate (HoLEP): a review and update. The Canadian journal of urology 2019; 26: 13-9
• 34 Morozov A, Taratkin M, Kozlov V. et al. Retrospective Assessment of Endoscopic Enucleation of Prostate Complications: A Single-Center Experience of More Than 1400 Patients. Journal of endourology 2020; 34: 192-7