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Abstract：
OBJECTIVE: The question of best surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) remains controversial. We compared the outcomes of aquablation and holmium laser enucleation of the prostate (\"HoLEP\") in a prospective cohort.
METHODS: Patients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume (\"PV\"), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo (\"CD\") classification.
RESULTS: We included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients\' larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation\'s results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01).
CONCLUSIONS: While aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.
METHODS: Patients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume (\"PV\"), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo (\"CD\") classification.
RESULTS: We included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients\' larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation\'s results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01).
CONCLUSIONS: While aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.
摘要：
目的：良性前列腺增生（BPH）引起的下尿路症状（LUTS）的最佳手术治疗问题仍存在争议。我们在前瞻性队列中比较了前列腺水消融和钬激光摘除术（“HoLEP”）的结果。
方法：BPH患者在2020年6月至2022年4月期间根据他们的偏好进行了水消融或HoLEP。前列腺体积（“PV”），实验室结果,后空隙残余体积，尿流仪,IPSS,ICIQ-SF,MSHQ-EjD,术前评估EES和IIEF，术后6个月和12个月。我们还通过ClavienDindo（“CD”）分类分析了围手术期特征和并发症。
结果：我们纳入了40例患者，其中16人接受了水消融和24HoLEP。平均年龄为67岁（SD7.4）。基线特征在组间平衡，除了HoLEP患者大PV。IPSS从基线时的20.3（SD7.1）下降到12个月时的6.3（SD4.2）（p<0.001），水消融和HoLEP之间没有差异。HoLEP与较短的手术时间相关（59.5（SD18.6）。87.2（SD14.8）分钟，p<0.001)，并导致所有时间点的PV降低更好。三个月后,在射精(p=0.02,MSHQ-EjD)和失禁功能(p<0.001,ICIQ-SF)方面,水消融的结果较好。超过三个月,勃起,射精,在水消融术和HoLEP之间,尿失禁功能和LUTS减少没有显著差异.水消融组有6例患者出现CD≥3b级并发症，而HoLEP组仅有1例（p=<0.01）。
结论：虽然水消融术显示三个月时射精和尿失禁的暂时性益处，HoLEP在手术时间上是优越的，安全性和体积结果。
方法：BPH患者在2020年6月至2022年4月期间根据他们的偏好进行了水消融或HoLEP。前列腺体积（“PV”），实验室结果,后空隙残余体积，尿流仪,IPSS,ICIQ-SF,MSHQ-EjD,术前评估EES和IIEF，术后6个月和12个月。我们还通过ClavienDindo（“CD”）分类分析了围手术期特征和并发症。
结果：我们纳入了40例患者，其中16人接受了水消融和24HoLEP。平均年龄为67岁（SD7.4）。基线特征在组间平衡，除了HoLEP患者大PV。IPSS从基线时的20.3（SD7.1）下降到12个月时的6.3（SD4.2）（p<0.001），水消融和HoLEP之间没有差异。HoLEP与较短的手术时间相关（59.5（SD18.6）。87.2（SD14.8）分钟，p<0.001)，并导致所有时间点的PV降低更好。三个月后,在射精(p=0.02,MSHQ-EjD)和失禁功能(p<0.001,ICIQ-SF)方面,水消融的结果较好。超过三个月,勃起,射精,在水消融术和HoLEP之间,尿失禁功能和LUTS减少没有显著差异.水消融组有6例患者出现CD≥3b级并发症，而HoLEP组仅有1例（p=<0.01）。
结论：虽然水消融术显示三个月时射精和尿失禁的暂时性益处，HoLEP在手术时间上是优越的，安全性和体积结果。
