Wie gut sind wir wirklich? Interventionsbedürftige Nachblutungen und intraoperative Elektrokoagulationen bei der Thulium-Laser-Enukleation der Prostata

Zusammenfassung

Die interventionsbedürftige Nachblutung stellt eine wichtige Komplikation bei der Thulium-Laser-Enukleation der Prostata (ThuLEP) dar. Ziel dieser Untersuchung war diese Komplikation bei der Behandlung einer benignen Prostatavergrößerung retrospektiv zu analysieren. Die Arbeit konzentriert sich auf die Untersuchung möglicher ursächlicher Faktoren für interventionsbedürftige Nachblutungen sowie die Anwendung einer intraoperativen Elektrokoagulation. Insgesamt wurden 503 ThuLEPs im Zeitraum von 08/2021–07/2022 untersucht.

Bei 4,2% (n=21) der Patienten trat postoperativ eine interventionsbedürftige Nachblutung auf. Die Daten konnten zeigen, dass bei diesen Nachblutungen eine signifikante Assoziation zwischen einem hohem Prostatavolumen, einem hohem Enukleationsgewicht sowie einer intraoperativen Elektrokoagulation bestand. Bei insgesamt 41,2% (n=207) der Fälle wurde intraoperativ eine Elektrokoagulation angewandt. In diesen Fällen bedingte statistisch signifikant eine intraoperative Kapselperforation sowie eine hohes Enukleationsgewicht die Anwendung einer Elektrokoagulation.

Abstract

The need for intervention due to postoperative bleeding represents a significant complication in Thulium Laser Enucleation of the Prostate (ThuLEP). This study aimed to retrospectively analyse this complication in the treatment of benign prostatic enlargement. This study focuses on investigating potential causative factors for postoperative bleeding requiring intervention as well as the use of intraoperative electrocoagulation. A total of 503 ThuLEP procedures performed between 08/2021 and 07/2022 were examined.

Postoperatively, 4.2% (n=21) of patients experienced bleeding requiring intervention. Study data revealed a significant association between these instances of bleeding and a high prostate volume (p=0.004), high enucleation weight (p=0.004), and intraoperative electrocoagulation (p=0.048). In total, intraoperative electrocoagulation was applied in 41.2% (n=207) of cases. In these cases, statistically significant factors leading to the application of electrocoagulation included intraoperative capsule perforation (p=0.005) and high enucleation weight (p=0.002).

Schlüsselwörter

Benigne Prostatahyperplasie - Thulium-Laser-Enukleation - Prostata - Komplikationen - Endourologie

Keywords

benign prostatic hyperplasia - thulium laser enucleation - prostate - complications

• Literatur

• 1 Untergasser G, Madersbacher S, Berger P. Benign prostatic hyperplasia: age-related tissue-remodeling. Exp Gerontol 2005; 40: 121-128
• 2 Issa MM, Fenter TC, Black L. et al. An assessment of the diagnosed prevalence of diseases in men 50 years of age or older. Am J Manag Care 2006; 12: S83-S89
• 3 Launer BM, McVary KT, Ricke WA. et al. The rising worldwide impact of benign prostatic hyperplasia. BJU Int 2021; 127: 722-728
• 4 Verhamme KMC, Dieleman JP, Bleumink GS. et al. Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care – the Triumph project. Eur Urol 2002; 42: 323-328
• 5 Bschleipfer T, Bach T, Berges R. et al. S2e guideline of the German urologists: Instrumental treatment of benign prostatic hyperplasia. Urologe A 2016; 55: 195-207
• 6 Reich O, Gratzke C, Bachmann A. et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 2008; 180: 246-249
• 7 Kaya E, Yılmaz S, Açıkgöz O. et al. Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP. Andrologia 2021; 53: e14125
• 8 Wani MM, Sriprasad S, Bhat T. et al. Is Thulium laser enucleation of prostate an alternative to Holmium and TURP surgeries – A systematic review?. Turk J Urol 2020; 46: 419-426
• 9 Zhang Y, Yuan P, Ma D. et al. Efficacy and safety of enucleation vs. resection of prostate for treatment of benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. Prostate Cancer Prostatic Dis 2019; 22: 493-508
• 10 Świniarski PP, Stępień S, Dudzic W. et al. Thulium laser enucleation of the prostate (TmLEP) vs. transurethral resection of the prostate (TURP): evaluation of early results. Cent European J Urol 2012; 65: 130-134
• 11 Bozzini G, Seveso M, Melegari S. et al. Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): A randomized prospective trial to compare intra and early postoperative outcomes. Actas Urol Esp 2017; 41: 309-315
• 12 Castellani D, Pirola GM, Rubilotta E. et al. GreenLight Laser™ Photovaporization versus Transurethral Resection of the Prostate: A Systematic Review and Meta-Analysis. Res Rep Urol 2021; 13: 263-271
• 13 Hartung FO, Kowalewski K-F, Hardenberg J von. et al. Holmium Versus Thulium Laser Enucleation of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2022; 8: 545-554
• 14 Becker B, Netsch C, Hansen J. et al. Perioperative Safety in Patient Under Oral Anticoagulation During Holmium Laser Enucleation of the Prostate. J Endourol 2019; 33: 219-224
• 15 El Tayeb MM, Jacob JM, Bhojani N. et al. Holmium Laser Enucleation of the Prostate in Patients Requiring Anticoagulation. J Endourol 2016; 30: 805-809
• 16 Bishop CV, Liddell H, Ischia J. et al. Holmium Laser Enucleation of the Prostate: Comparison of Immediate Postoperative Outcomes in Patients with and without Antithrombotic Therapy. Curr Urol 2013; 7: 28-33
• 17 Shah A, Stanworth SJ, McKechnie S. Evidence and triggers for the transfusion of blood and blood products. Anaesthesia 2015; 70 (Suppl. 01) 10-19, e3–e5
• 18 Ortner G, Güven S, Somani BK. et al. Experts’ recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. World J Urol 2023; 41: 3277-3285
• 19 Porreca A, Schiavina R, Romagnoli D. et al. T-L technique for HoLEP: perioperative outcomes of a large single-centre series. Cent European J Urol 2021; 74: 366-371
• 20 Kim S-H, Son H-J, Kim J-W. et al. Severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser enucleation and morcellation of the prostate: a case report. Korean J Anesthesiol 2016; 69: 185-188