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Holmiumlaserablation der Prostata

Eine Alternative zum KTP

Holmium laser ablation of the prostate

An alternative to GreenLight photoselective vaporization of the prostate

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Zusammenfassung

Ziele

Ablative Laserverfahren zur Therapie der benignen Prostataobstruktion (BPO) gewinnen aufgrund potenziell geringerer Komplikationsraten als quasi ambulante Therapieformen an Bedeutung. Ziel dieser prospektiven Phase-II-Studie war die Erfassung der Effektivität und der Komplikationen der Holmiumlaserablation der Prostata (HoLAP) im 1. postoperativen Jahr.

Material und Methoden

Von 06/2006 bis 12/2007 wurden 86 von 343 konsekutiven Patienten mit BPO (IPSS>10) mit dem Versapulse®-100-W-Laser (Lumenis®) mit 2,0 J/50 Hz oder 3,2 J/25 Hz behandelt. PSA, Qmax, IPSS („International Prostate Symptom Score“), Prostatavolumen und Restharn wurden prä- und postoperativ prospektiv erfasst. Das mediane Follow-up beträgt 8 (3–21) Monate.

Ergebnisse

Das Alter lag bei 71 (9–135) Jahren. Die Operationszeit betrug 77,5 min. Es gab nur eine substitutionsbedürftige Blutung. In 14/86 Fällen (16%) wurde die HoLAP mit einer transurethralen Resektion der Prostata (TURP) kombiniert. Kurzzeitige dysurische Beschwerden traten bei 26,7% der befragten Patienten auf. Die Krankenhausverweildauer lag in den meisten Fällen <48 h. IPSS, QoL, Qmax, PSA, RH und Volumen haben sich nach 3 Monaten signifikant verbessert, alle Parameter bleiben nach 12 Monaten unverändert. Die Reoperationsrate in 12 Monaten beträgt 6,8%.

Schlussfolgerung

Der Vorteil der HoLAP gegenüber der TURP ist die sehr geringe Blutungsrate und damit kurze Krankenhausverweildauer und mögliche ambulante Therapie. Besonders Patienten mit einer Prostata <50 ml profitieren von der HoLAP. Postoperative Dysurien sind der Symptomatik nach TURP vergleichbar. Langzeitergebnisse müssen die geringe Reoperationsrate bestätigen.

Abstract

Introduction

Ablative laser methods for treating benign prostatic obstruction (BPO) have gained importance because of potentially lower complication rates than outpatient therapy methods. The aim of this prospective phase II study was to record the effectiveness and complications of holmium laser ablation of the prostate (HoLAP) in the first postoperative year.

Material and methods

June 2006 to December 2007, 86 of 343 consecutive patients with BPO [International Prostate Symptom Score (IPSS) >10] were treated with the VersaPulse 100-W laser (Lumenis), 2.0 J/50 Hz or 3.2 J/25 Hz. Preoperative and postoperative prostate-specific antigen (PSA), peak urinary flow rate (Qmax), IPSS, prostate gland volume, and postvoid urine volume were prospectively measured. The median follow-up time was 8 months (3–21).

Results

Median patient age was 71 (50–83) years, and mean operating time was 77.5 (9–135) min. There was only one case of significant bleeding. In 14 of 86 cases (16%), HoLAP was combined with transurethral resection of the prostate (TURP). Short-term voiding complaints were expressed by 26.7% of the questioned patients. The length of hospital stay was in most cases <48 h. IPSS, Qmax, PSA, postvoid urine, gland volumes, and quality of life improved significantly after 3 months, and all parameters remained unchanged after 12 months. The reoperation rate within 12 months was 6.8%.

Conclusions

The advantage of HoLAP over TURP is the very low bleeding rate and thus a shorter hospital stay and possible outpatient therapy. In particular, patients with prostate gland volume <50 ml profit from HoLAP. Postoperative voiding complaints are comparable to those with TURP. Long-term results are needed to confirm the low reoperation rate.

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Authors and Affiliations

  1. Klinik für Urologie, Nephrologisches Zentrum Niedersachsen, AWO-GSD gGmbH, Vogelsang 105, 34336, Hann. Münden, Deutschland

    M. Richter

  2. Klinik für Urologie, Klinikum Kassel, Gesundheitsholding Nordhessen GmbH, Kassel, Deutschland

    J. Schwarz & P. De Geeter

  3. Klinik für Urologie, Universitätsklinik, Düsseldorf, Deutschland

    P. Albers

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  1. M. Richter
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  2. J. Schwarz
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  3. P. De Geeter
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  4. P. Albers
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Correspondence to M. Richter.

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Richter, M., Schwarz, J., De Geeter, P. et al. Holmiumlaserablation der Prostata. Urologe 48, 291–295 (2009). https://doi.org/10.1007/s00120-008-1926-8

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  • DOI: https://doi.org/10.1007/s00120-008-1926-8

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