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홀렙수술에서 경요도 지혈술의 위험인자: 전향적 연구 |
| ¹서울대학교병원 비뇨의학과 |
| 윤현식¹, 김민혁¹, 박재석¹, 정대혁¹, 서준교¹, 조성용¹, 오승준¹ |
Objective
We aimed to identify risk factors for transurethral coagulation (TUC) during HoLEP surgery.
Patients and Methods
We analyzed clinical outcomes of HoLEP surgery performed by a single surgeon between July 2008 and April 2020 at Seoul National University Hospital. Patients were in a prospective cohort of SNUH BPH Database Registry. Preoperative parameters were age, BMI, a drug used, underlying disease, IPSS, QoL scores, PSA, Qmax, postvoid residual urine (PVR), total prostate volume (TPV), and transition zone volume (TZV). Intraoperative parameters were operation time, enucleation time, morcellation time, enucleation weight, intraoperative complications. Logistic regression analysis was used to identify risk factors.
Results
Among a total of 1,645 patients, the 382 patients who underwent TUC (TUC group) (adjuvant(n=322, 84%), salvage(16%)) were older (mean ± SD; 70.5 ± 7.1 vs. 69.2 ± 6.9 years, p=0.003) and had more 5-ARI use (34.6% vs. 25.2%, p<0.001), less anticholinergics use (10.2% vs. 14.3%, p=0.042), higher PSA (5.3 ± 4.8 vs. 3.7 ± 4.4 ng/mL, p<0.001), larger TPV (87.7 ± 44.2 vs. 65.5 ± 32.2 mL, p<0.001), and larger TZV (55.8 ± 34.7 vs. 37.2 ± 23.9 mL, p<0.001) than those who did not undergo TUC (non-TUC group). All intraoperative parameters were significantly higher in the TUC group than in the non-TUC group (p<0.001). In univariable logistic regression analysis, age, anticholinergics use, 5-ARI use, PSA, TPV, and TZV correlated with TUC. In multivariable logistic regression analysis, only TZV associated with TUC. Compared to TZV<30mL, odd ratio[OR] was 1.95 in 30mL≤TZV<50mL (95% CI 1.40-2.73, p<0.001), 3.11 in 50mL≤TZV<70mL (95% CI 2.14-4.53, p<0.001), 5.60 in ≥70mL (95% CI 3.87-8.09, p<0.001), respectively.
Conclusions
Risk of TUC during HoLEP surgery increases in patients who have TZV larger than 30mL. |
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keywords : HoLEP, Transurethral coagulation, Benign prostatic hyperplasia |
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