Técnica minimamente invasiva de enucleação da próstata com Holmium Laser (MiLEP) – resultados prospectivos

Abstract

Introduction: This study aims to prospectively analyze the Prostate Enucleation procedure with Holmium Laser using the minimally invasive technique (MiLEP), comparing the outcomes and their variables pre- and post-operatively. Materials and methods: Were studied men with IPSS > 7, prostate > 35 cm³ and with an indication for a surgical procedure for BPH. We performed flowmetry and administered the IPSS questionnaire before and 6 months after the procedure. The patients were operated on with a 60W Holmium Laser (Cyber-Ho Quanta System®) using 54W of power (energy 1.8J and frequency of 30Hz). Enucleation was performed using the en bloc technique and the endoscopic material consisted of a continuous flow resectoscope (RZ®) 22 Fr with a working element compatible with a 550-micrometer laser fiber. After enucleation, the tissue was morcellated with a 22 FR morcellator Piranha (Richard Wolf). Student's T test and Man-Whitney was used to statistical analysis (p<0.05). Results: Were analyzed 73 patients (mean age= 68.2 years) with a follow up of 3 months. The urinary continence rate after the procedure was greater than 95% after 1 week and 99% in the 1st month. All patients were continent after 6 months. The IPSS questionnaire before (mean=21.18 points/SD=6.557) and after (mean=7.92 points/SD=2.408) the MiLEP had statistical significance (p< 0.001). The flowmetry(ml/s) before (9.02/SD=2.842) and after (21.07/SD= 6.228) the MiLEP had statistical significance (p<0.001). The average time of the procedure was 78.5 minutes and the bladder catheter was removed after 18 hours in mean. In 4 patients (5.8%) were observed hematuria and in 1 case (1.47%) the patient needs urinary catheterization. Conclusion: MiLEP is a safe and effective procedure, with significant improvement in urinary flow and symptoms in the short term. However, multicenter studies with longer follow-up are needed to confirm these findings.