Holmiyum Lazer Prostat Enükleasyonunun (HoLEP) Ürodinamik Parametreler ve Mesane Fonksiyonu Üzerindeki Etkisi: Retrospektif Bir Analiz

Yıl 2025, Cilt: 17 Sayı: 3, 139 - 146, 30.09.2025

Yunus Çolakoğlu , Çağrı Şevik , Emre Korkmaz Metin Savun , Abdülmüttalip Şimşek

https://doi.org/10.54233/endourolbull-1721693

Öz

Amaç: Bu çalışma, Holmiyum Lazer Prostat Enükleasyonunun (HoLEP) benign prostat hiperplazisi (BPH) hastalarında ürodinamik parametreler ve mesane fonksiyonu üzerindeki etkisini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntemler: Üçüncü basamak bir sağlık merkezinde HoLEP uygulanan, ürodinamik olarak doğrulanmış BPH tanısı konmuş 44 hastanın retrospektif analizi yapıldı. Ameliyat öncesi ve 6 ay sonrası değerlendirmeler, Uluslararası Prostat Semptom Skoru (IPSS), üroflowmetri, idrar sonrası rezidüel hacim (PVR) ve detrüsör basıncı, maksimum akış hızı (Qmax), mesane çıkış obstrüksiyon indeksi (BOOI) ve detrüsör aşırı aktivitesini (DO) ölçen ürodinamik çalışmaları içermekteydi. İstatistiksel karşılaştırmalar eşleştirilmiş t-testleri, Wilcoxon işaretli sıralar testi ve McNemar testi ile yapıldı.
Bulgular: HoLEP sonrası IPSS (22,0 ± 7,0’den 6,1 ± 5,0’e, p<0,001), pollaküri (7,4 ± 1,5’ten 5,8 ± 1,2’ye, p=0,01), nokturi (3,2 ± 0,8’den 1,1 ± 0,5’e, p<0,001) ve PVR (175,0 ± 50,0’den 45,4 ± 15,0 mL’ye, p<0,001) anlamlı ölçüde azaldı. Qmax 6,8 ± 2,0’den 19,7 ± 4,5 mL/s’ye (p<0,001), maksimum mesane kapasitesi 180,0 ± 45,0’den 375,0 ± 75,0 mL’ye (p<0,001) ve maksimum sistometrik kapasite 280,0 ± 56,0’dan 415,0 ± 83,0 mL’ye (p<0,001) yükseldi. BOOI 75,9 ± 15,0’den -8,5 ± 5,0’e düştü (p<0,001). Zayıf mesane kompliyansı ve DO prevalansı azaldı (sırasıyla %13,6’dan %6,8’e, p=0,30; %25,0’den %11,3’e, p=0,10), ancak bu değişiklikler istatistiksel olarak anlamlı değildi.
Sonuç: HoLEP, özellikle karmaşık ürodinamik profillere sahip BPH hastalarında ürodinamik parametreleri ve mesane fonksiyonunu anlamlı ölçüde iyileştirir. Bu bulgular, HoLEP’in mesane çıkış obstrüksiyonunu gidermede ve alt üriner sistem semptomlarını iyileştirmede etkili bir tedavi olduğunu desteklerken, detrüsör aşırı aktivitesi ve mesane kompliyansı için potansiyel faydalar sunar.

Anahtar Kelimeler

alt üriner sistem semptomları , BPH , HoLEP , ürodinamik parametre

Etik Beyan

Bu çalışma için etik onay, İstanbul İl Sağlık Müdürlüğü Başakşehir Çam ve Sakura Şehir Hastanesi Klinik Araştırma Etik Kurulu'ndan alınmıştır (Etik kurul onay tarihi ve numarası: 08.11.2023/KAEK/2023.11.560).

Destekleyen Kurum

Yazarlar, bu çalışmanın herhangi bir finansal destek almadığını beyan ederler.

The Effects of Holmium Laser Enucleation of the Prostate (HoLEP) on Urodynamic Parameters and Bladder Function: A Retrospective Analysis

Öz

Objective: This study evaluates the impact of Holmium Laser Enucleation of the Prostate (HoLEP) on urodynamic parameters and bladder function in patients with benign prostatic hyperplasia (BPH).
Material And Methods: A retrospective analysis was conducted on 44 patients with urodynamically confirmed BPH who underwent HoLEP in a tertiary care center. Preoperative and 6-month postoperative assessments included the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual (PVR) volume, and urodynamic studies measuring detrusor pressure, maximum flow rate (Qmax), bladder outlet obstruction index (BOOI), and detrusor overactivity (DO). Statistical comparisons were conducted using paired t-tests, Wilcoxon signed-rank tests, and McNemar’s test.
Results: Significant improvements were observed post-HoLEP, including a reduction in IPSS (22.0 ± 7.0 to 6.1 ± 5.0, p<0.001), daytime frequency (7.4 ± 1.5 to 5.8 ± 1.2, p=0.01), nocturia (3.2 ± 0.8 to 1.1 ± 0.5, p<0.001), and PVR (175.0 ± 50.0 to 45.4 ± 15.0 mL, p<0.001). Qmax increased from 6.8 ± 2.0 to 19.7 ± 4.5 mL/s (p<0.001), maximum bladder capacity from 180.0 ± 45.0 to 375.0 ± 75.0 mL (p<0.001), and maximum cystometric capacity from 280.0 ± 56.0 to 415.0 ± 83.0 mL (p<0.001). BOOI decreased from 75.9 ± 15.0 to-8.5 ± 5.0 (p<0.001). Poor bladder compliance and DO prevalence decreased (13.6% to 6.8%, p=0.30; 25.0% to 11.3%, p=0.10), though not statistically significant.
Conclusion: HoLEP significantly improves urodynamic parameters and bladder function in BPH patients, particularly in those with complex urodynamic profiles. These findings support HoLEP as an effective treatment for relieving bladder outlet obstruction and improving lower urinary tract symptoms, with potential benefits for detrusor overactivity and bladder compliance.

Anahtar Kelimeler

benign prostatic hyperplasia (BPH) , holmium laser enucleation of the prostate (HoLEP) , lower urinary tract symptoms , urodynamic parameters

Etik Beyan

Ethical approval for this study was obtained from the Clinical Research Ethics Committee of Başakşehir Çam and Sakura City Hospital, Istanbul Provincial Health Directorate (Ethics committee approval date and number: 08.11.2023/KAEK/2023.11.560).

Destekleyen Kurum

The authors declare that this study received no financial support.

Kaynakça

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