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Dergiler / Harran Üniversitesi Tıp Fakültesi Dergisi / 2025 / Cilt: 22 Sayı: 4

Holmium Laser Prostat Enükleasyon (HOLEP) Cerrahisinde En-bloc ve Three-lobe Tekniklerinin Karşılaştırılması: Tek Merkez Sonuçlarımız

Comparison of En-bloc Vs. Three-lobe Techniques of Holmium Laser Enucleation of Prostate (HOLEP): A Single Center Experience

Erdinç Dinçer(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER)0000-0002-0644-8282
Orkunt Özkaptan(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0003-3659-1319
Cengiz Canakcı(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-2654-1986
Utku Can(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-9805-3930
Tahsin Batuhan Aydoğan(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-2000-7790
Mehmet Burak Doğrusever(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0009-0001-7719-307X
Sayfa
800–805
Yayın Tarihi
2025-12-25
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⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Bulgular: İki grup arasında yaş, PSA ve operasyon öncesi üroflowmetri sonuçları açısından farklılık saptanmadı.

📌 3 Maddede Bu Makale

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Amaç & Hipotez:Amaç: Holmium lazer prostat enükleasyon (HOLEP) cerrahisi, benign prostat hiperplazisi tedavisinde önemli bir rol oynamaktadır.
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Temel Bulgular & Veri:Bu çalışmada, en-bloc teknik ile three-lobe tekniğin etkinlik ve güvenilirliğini karşılaştırmayı amaçladık.
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Sonuç & Katkı:Bulgular: İki grup arasında yaş, PSA ve operasyon öncesi üroflowmetri sonuçları açısından farklılık saptanmadı.
🔬Tür:Literatür & Derleme Çalışması
📍Kapsam:80 hasta
⚙️Değişkenler:En-bloc · Three-lobe · HOLEP

Özet

Amaç: Holmium lazer prostat enükleasyon (HOLEP) cerrahisi, benign prostat hiperplazisi tedavisinde önemli bir rol oynamaktadır. Klasik three-lobe tekniğin tanımlanmasından sonra, çok sayıda yeni teknik literatüre sunulmuştur. Bu çalışmada, en-bloc teknik ile three-lobe tekniğin etkinlik ve güvenilirliğini karşılaştırmayı amaçladık. Materyal ve metod: 3. basamak bir merkezde, HoLEP cerrahisi uygulanan 80 hastanın verileri retrospektif olarak incelendi. Hastalar 2 gruba ayrıldı (en-bloc:40, three-lobe:40). Tüm hastaların yaş, preoperatif PSA, prostat hacmi, maksimum akış hızı (Qmax), enükleasyon süresi, morselasyon süresi, enükleasyon etkinliği (çıkarılan doku/enükleasyon süresi), morselasyon etkinliği (çıkarılan doku/morselasyon süresi), peroperatif ve postoperatif komplikasyonları kaydedildi. Bulgular: İki grup arasında yaş, PSA ve operasyon öncesi üroflowmetri sonuçları açısından farklılık saptanmadı. Operasyon öncesinde, en-bloc grubunda 8 ve three-lobe grubunda 11 hastada üretral kateter mevcuttu. Enükleasyon süresi en-bloc grubunda istatistiksel olarak daha kısa bulunurken (p<0,001), morselasyon süresi iki grupta da benzer bulundu (p=0,706). Preoperatif prostat hacmi three-lobe grubunda yüksek olmasına rağmen (p=0,013), iki grup arasında çıkartılan doku hacmi açısından anlamlı farklılık saptanmadı (p=0,261). Postoperatif üroflowmetri sonuçları açısından iki grup arasından farklılık saptanmadı (p=0,628). En-bloc grubunda 2, three-lobe grubunda 4 hastada postoperatif hematüri izlendi. En-bloc grubunda 6, three-lobe grubunda 7 hastada uzamış inkontinans tespit edildi. Total komplikasyon oranı açısından iki grup arasında anlamlı farklılık saptanmadı. Sonuç: Çalışmamızın sonuçlarını incelediğimizde, her iki tekniğin de benzer şekilde tatmin edici sonuçlar ve benzer geç komplikasyon oranları sağladığını gözlemledik. Ancak en-bloc tekniği, anlamlı derecede daha kısa bir enükleasyon süresi ve daha kısa toplam ameliyat süresi göstermektedir.

Abstract

Background: Holmium laser enucleation of the prostate (HOLEP) surgery has played a significant role in the treatment of benign prostatic hyperplasia. Since the definition of the classical three-lobe technique, many new techniques have been introduced. We aimed to compare the efficacy and safety of the en bloc and three-lobe techniques used in this surgery. Material and Methods: Medical data of 80 patients who underwent HoLEP surgery at a tertiary center were evaluated retrospectively. The patients were divided into 2 groups (en-bloc: 40, three-lobe: 40). All patients were evaluated for age, preoperative PSA, prostate size, maximum flow rate (Qmax), enucleation time, morcellation time, enucleated tissue weight, enucleation time efficacy (enucleated weight/enucleation time), morcellation time efficacy (enucleated weight/morcellation time), perioperative and postoperative complications and incontinence status. Results: There was no significant difference between the two groups in terms of age, PSA, and preoperative uroflowmetry results. 8 patients in the en-bloc group and 11 patients in the three-lobe group had a catheter preoperatively. Enucleation time was significantly shorter in the en-bloc group (p<0.001), while morcellation time was similar (p=0.706). Although the prostate volume was higher in the three-lobe group (p=0.013), no difference was observed in terms of enucleated tissue weight (p=0.261). Postoperative uroflowmetry results were similar in the two groups (p=0.628). Postoperative hematuria was observed in 2 patients in the en-bloc group and 4 patients in the three-lobe group. Prolonged incontinence developed in 6 patients in the en-bloc group and in 7 patients in the three-lobe group. No statistically significant difference was observed between the two groups in terms of complications. Conclusion: In reviewing the results of our study, we observed that both techniques yield comparably satisfactory outcomes and similar rates of late complications. However, the en-bloc technique demonstrates a significantly shorter enucleation time as well as a reduced overall operative duration.

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Bu Makaleye Atıf Yap

Dinçer, E., Özkaptan, O., Canakcı, C., Can, U., Aydoğan, T. B., Doğrusever, M. B. (2025). Holmium Laser Prostat Enükleasyon (HOLEP) Cerrahisinde En-bloc ve Three-lobe Tekniklerinin Karşılaştırılması: Tek Merkez Sonuçlarımız. Harran Üniversitesi Tıp Fakültesi Dergisi, Cilt: 22 Sayı: 4, 800–805. https://doi.org/10.35440/hutfd.1690946

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