前列腺钬激光剜除术与经尿道前列腺电切术近期临床疗效比较
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摘要
目的：比较前列腺钬激光剜除术（HoLEP）和经尿道前列腺电切术（TURP）近期临床疗效，期望对前列腺钬激光剜除术做出较为全面、客观的评价，为该技术的临床应用提供依据。
方法：将2001年11月至2002年10月满足本课题病例纳入标准和剔除标准的良性前列腺增生症（BPH）患者随机分为两组，分别行 HoLEP和TURP，得到HoLEP组和TURP组各70例。前瞻性设计两组患者术前、术中、术后
及术后3月、6月复查指标，通过
将所测指标进行统计学分析，比较两种术式治疗BPH的近期临床疗效。
结果：术后3月、6月均来我科复查者，HoLEP组55例，TURP组58例。（1）术前两组患者年龄、病史、前列腺重量、前列腺指肛检查结果、合并症情况及IPSS、QOLS、Qmax、Pdet/Qmax、残余尿（RUV）比较无显著差异（P>0.05）；（2）术后3、6月，两组患者IPSS、QOLS、Qmax、Pdet/Qmax、RUV均比术前得到明显改善（P<0.01），改善程度两组间无显著差异（P>0.05）；（3）手术时间及尿道狭窄、再手术率、逆行射精等近期术后并发症两组间无显著差异（P>0.05）；但术中输血率、TURS发生率、术后平均膀胱冲洗时间、置管时间和住院时间，HoLEP组明显小于TURP组（P<0.01）。
结论：（1）HoLEP治疗良性前列腺增生症具有与TURP相同的近期临床疗效；（2）术中并发症发生率及患者术后恢复时间，HoLEP明显少于TURP；（3）HoLEP是目前BPH激光疗法中最有望替代TURP的一种新方法，其远期疗效有待进一步观察。
Objective: To get an all around, objective assessment on holmium laser enucleation of the prostate (HoLEP) ,which is a new technique on the treatment of benign prostatic hyperplasia (BPH) in our country, through comparing therapy results in the near future of HoLEP with thansurethal resection of the prostate(TURP) directly.
Methods: In the randomized comparison, we made out the indexes which would be monitored and recorded during the research prospectively. A total of 140 men with symptomatic BPH and meeting the criterions of the research were treated with either HoLEP or TURP during the period from November 2001 to Octorber 2002 in our center, thus the patients were divided into two groups: Group HoLEP and Group TURP, 70 patients each group. Standard assessments including International Prostate Symptom Score(IPSS), Quality of Life Score(QOLS), prostate specific antigen(PSA), digital rectal examination, pressure-flow urodynamics，ultrasound prostate volume and post-voiding residual urine measurement were performed in each patient preoperatively. Operation time , postoperative bladder irrigating time and catheterizing time were recorded. IPSS, QOLS, uroflometry were repeated respectively at both 3 and 6- months visit. Pressure-flow urodynamics was also repeated at 6 months postoperatively. All complications were noted. The data was performed statistical analysis.
Results: 55 patients in Group HoLEP and 58 in Group TURP were visited at both 3 and 6 months.There was no significant difference between the two groups for any preoperative parameter. Both holmium laser and transurethral resections resulted in significant improvements in IPSS, QOLS, peak urinary flow rate(Qmax), detrusor pressure at Qmax(Pdet/Qmax) and post-voiding residual urine volumn(RUV). The degree of improvements was similar between the two groups(P>0.05). Operation time was almost equivalent but postoperative bladder irrigating time, catheterizing time and admission days of HoLEP group were significant less compared to the TURP group. There were fewer side effects such as blood transfusion, transurethral resection syndrome(TURS) in the holmium
group. Effects on retrograde ejaculation, urethral stricture and reoperation rate were similar with 6-months followup.
Conclusions: (1) HoLEP is as effective as TURP for the treatment of symptomatic BPH in the near future according to our research results. (2) HoLEP yields fewer adverse side effects and less recovering time compared to TURP. (3)HoLEP may be a substitute for TURP.
方法：将2001年11月至2002年10月满足本课题病例纳入标准和剔除标准的良性前列腺增生症（BPH）患者随机分为两组，分别行 HoLEP和TURP，得到HoLEP组和TURP组各70例。前瞻性设计两组患者术前、术中、术后
及术后3月、6月复查指标，通过
将所测指标进行统计学分析，比较两种术式治疗BPH的近期临床疗效。
结果：术后3月、6月均来我科复查者，HoLEP组55例，TURP组58例。（1）术前两组患者年龄、病史、前列腺重量、前列腺指肛检查结果、合并症情况及IPSS、QOLS、Qmax、Pdet/Qmax、残余尿（RUV）比较无显著差异（P>0.05）；（2）术后3、6月，两组患者IPSS、QOLS、Qmax、Pdet/Qmax、RUV均比术前得到明显改善（P<0.01），改善程度两组间无显著差异（P>0.05）；（3）手术时间及尿道狭窄、再手术率、逆行射精等近期术后并发症两组间无显著差异（P>0.05）；但术中输血率、TURS发生率、术后平均膀胱冲洗时间、置管时间和住院时间，HoLEP组明显小于TURP组（P<0.01）。
结论：（1）HoLEP治疗良性前列腺增生症具有与TURP相同的近期临床疗效；（2）术中并发症发生率及患者术后恢复时间，HoLEP明显少于TURP；（3）HoLEP是目前BPH激光疗法中最有望替代TURP的一种新方法，其远期疗效有待进一步观察。
Objective: To get an all around, objective assessment on holmium laser enucleation of the prostate (HoLEP) ,which is a new technique on the treatment of benign prostatic hyperplasia (BPH) in our country, through comparing therapy results in the near future of HoLEP with thansurethal resection of the prostate(TURP) directly.
Methods: In the randomized comparison, we made out the indexes which would be monitored and recorded during the research prospectively. A total of 140 men with symptomatic BPH and meeting the criterions of the research were treated with either HoLEP or TURP during the period from November 2001 to Octorber 2002 in our center, thus the patients were divided into two groups: Group HoLEP and Group TURP, 70 patients each group. Standard assessments including International Prostate Symptom Score(IPSS), Quality of Life Score(QOLS), prostate specific antigen(PSA), digital rectal examination, pressure-flow urodynamics，ultrasound prostate volume and post-voiding residual urine measurement were performed in each patient preoperatively. Operation time , postoperative bladder irrigating time and catheterizing time were recorded. IPSS, QOLS, uroflometry were repeated respectively at both 3 and 6- months visit. Pressure-flow urodynamics was also repeated at 6 months postoperatively. All complications were noted. The data was performed statistical analysis.
Results: 55 patients in Group HoLEP and 58 in Group TURP were visited at both 3 and 6 months.There was no significant difference between the two groups for any preoperative parameter. Both holmium laser and transurethral resections resulted in significant improvements in IPSS, QOLS, peak urinary flow rate(Qmax), detrusor pressure at Qmax(Pdet/Qmax) and post-voiding residual urine volumn(RUV). The degree of improvements was similar between the two groups(P>0.05). Operation time was almost equivalent but postoperative bladder irrigating time, catheterizing time and admission days of HoLEP group were significant less compared to the TURP group. There were fewer side effects such as blood transfusion, transurethral resection syndrome(TURS) in the holmium
group. Effects on retrograde ejaculation, urethral stricture and reoperation rate were similar with 6-months followup.
Conclusions: (1) HoLEP is as effective as TURP for the treatment of symptomatic BPH in the near future according to our research results. (2) HoLEP yields fewer adverse side effects and less recovering time compared to TURP. (3)HoLEP may be a substitute for TURP.
引文
1. 顾方六。良性前列腺增生和前列腺癌的流行病学。实用医学杂志 2000.12.25; 16(12): 977-978
2. Yamamoto,-M; Hibi,-H; Miyake,-K. A comparison of transurethral resection of the prostate and medical treatment for the patient with moderate symptoms of benign prostatic hyperplasia.Nagoya-J-Med-Sci. 1996 Mar; 59(1-2): 11-6
3. Manyak,-M-J; Aulisi,-G-P. Free-beam and contact laser ablation of benign prostatic hyperplasia with the KTP/Nd:YAG laser: efficacy and versatility.World-J-Urol. 1995; 13(2): 104-8
4. Narayan,-P; Fournier,-G; Indudhara,-R, et al. Transurethral evaporation of prostate (TUEP) with Nd:YAG laser using a contact free beam technique: results in 61 patients with benign prostatic hyperplasia.Urology. 1994 Jun; 43(6): 813-20
5. Jung,-P; Mattelaer,-P; Wolff,-J-M, et al. Visual laser ablation of the prostate: efficacy evaluated by urodynamics and compared to TURP.Eur-Urol. 1996; 30(4): 418-23
6. Tuhkanen,-K; Heino,-A; Ala-Opas,-M. Contact laser prostatectomy compared to TURP in prostatic hyperplasia smaller than 40 ml. Six-month follow-up with complex urodynamic assessment.Scand-J-Urol-Nephrol. 1999 Feb; 33(1): 31-4
7. Costello,-A-J; Crowe,-H-R; Jackson,-T, et al. A randomised single institution study comparing laser prostatectomy and transurethral resection of the prostate.Ann-Acad-Med-Singapore. 1995 Sep; 24(5): 700-4
8. Anson,-K; Nawrocki,-J; Buckley,-J, et al. A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate. Urology. 1995 Sep; 46(3): 305-10
9. Delvecchio,-F-C; Preminger,-G-M Curr-Opin -Urol. Endoscopic management of urologic disease with the holmium laser. 2000 May; 10(3): 233-7.
10. Gilling,-P-J; Cass,-C-B; Cresswell,-M-D, et al. The use of the holmium laser in the treatment of benign prostatic hyperplasia.J-Endourol. 1996 Oct; 10(5): 459-61
11. Gilling,-P-J; Cass,-C-B; Cresswell,-M-D, et al. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia.Urology. 1996 Jan; 47(1): 48-51
12. Kubba,-A-K; Greig,-J-D; Wallace,-I-W. Transurethral resection of the prostate in 539 patients at a district general hospital.J-R-Coll-Surg-Edinb. 1995 Aug; 40(4): 240-2
13. Koshiba,-K; Egawa,-S; Ohori,-M, et al. Does transurethral resection of the prostate pose a risk to life? 22-year outcome.J-Urol. 1995 May; 153(5): 1506-9
14. Bartoloni,-A; Gottin,-L; Ficarra,-V, et al. The TURP syndrome: importance of expiratory ethanol measurement and high serum levels of glycine.Arch-Esp-Urol. 2001 Jun; 54(5): 480-7
15. Paul,-A-B; Chisholm,-G-D. How dangerous is TURP?J-R-Coll-Surg-Edinb. 1993 Dec; 38(6): 333-4
16. Trepanier,-C-A; Lessard,-M-R; Brochu,-J, et al. Another feature of TURP syndrome: hyperglycaemia and lactic acidosis caused by massive absorption of sorbitol. Br-J-Anaesth. 2001 Aug; 87(2): 316-9
17. Mazur,-A-W; Thompson,-I-M. Efficacy and morbidity of "channel" TURP.Urology. 1991 Dec; 38(6): 526-8
18. Yeoh,-N; Inbasegaran,-K. A personal experience with the first 100 TURP at the Penang General Hospital.Med-J-Malaysia. 1989 Jun; 44(2): 129-33
19. Littlejohn,-Joe-O Jr; Ghafar,-Mohamed-A; Kang,-Young-M, et al. Transurethral resection of the prostate: the new old standard.Curr-Opin-Urol. 2002 Jan; 12(1): 19-23
20. Te,-A-E; Reis,-R; Kaplan,-S-A. TVP: a new modification of TURP.Contemp-Urol. 1995 May; 7(5): 74-8, 81-3
21. Patel,-A; Fuchs,-G-J; Gutierrez-Aceves,-J, et al. Transurethral electrovaporization and vapour-resection of the prostate: an appraisal of possible electrosurgical alternatives to regular loop resection.BJU-Int. 2000 Jan; 85(2): 202-10
22. Talic,-R-F; Al-Rikabi,-A-C. Transurethral vaporization-resection of the prostate versus standard transurethral prostatectomy: comparative changes in histopathological features of the resected specimens.Eur-Urol. 2000 Mar; 37(3): 301-5
23. Netto,-N-R Jr; De-Lima,-M-L; Lucena,-R, et al. Is transurethral vaporization a remake of transurethral resection of the prostate? J-Endourol. 1999 Oct; 13(8): 591-4
24. Zhou,-Z; Wang,-Z; Chen,-C, et al. Transurethral prostate vaporization using an oval electrode in 82 cases of benign prostatic hyperplasia. Chin-Med-J-(Engl). 1998 Jan; 111(1): 52-5
25. Aytac,-S; Yilmaz,-E; Budak,-M. Kupeli,-S; Baltaci,-S; Soygur,-T, et al. A prospective randomized study of transurethral resection of the prostate and transurethral vaporization of the prostate as a therapeutic alternative in the management of men with BPH.Eur-Urol. 1998; 34(1): 15-8
26. Gerber,-G-S; Jahoda,-A; Bales,-G-T, et al. Transurethral vaporization of the prostate in the treatment of bladder outlet obstruction at two university hospitals.Tech-Urol. 1997 Spring; 3(1): 25-9
27. Dimitri,-M. TURP with the new superpulsed radiofrequency energy: More than a gold standard.Eur-Urol. 1999 Oct; 36(4): 331-4
28. Faul,-P; Farin,-G; Reich,-O, et al. The 'band electrode': first experiences with a novel TURP procedure to improve hemostasis. Eur-Urol. 1996; 30(3): 403-8
29. Talic,-R-F; Al-Kudair,-W-K; El-Tiraifi,-A-E, et al. The 'Wing' versus the 'Vapor Cut' electrodes in transurethral electrovaporization- resection of the prostate: comparative changes in safety parameters.Urol-Int. 2000; 65(2): 95-9
30. Hammadeh,-M-Y; Madaan,-S; Singh,-M, et al. A 3-year follow-up of a prospective randomized trial comparing transurethral electrovaporization of the prostate with standard transurethral prostatectomy.BJU-Int. 2000 Oct; 86(6): 648-51
31. Talic,-R-F; El-Tiraifi,-A; El-Faqih,-S-R, et al. Prospective randomized study of transurethral vaporization resection of the prostate using the thick loop and standard transurethral prostatectomy.Urology. 2000 Jun; 55(6): 886-90; discussion 890-1
32. Kupeli,-S; Yilmaz,-E; Soygur,-T, et al. Randomized study of transurethral resection of the prostate and combined transurethral resection and vaporization of the prostate as a therapeutic alternative in men with benign prostatic hyperplasia.J-Endourol. 2001 Apr; 15(3): 317-21
33. Ekengren,-J; Haendler,-L; Hahn,-R-G. Clinical outcome 1 year after transurethral vaporization and resection of the prostate.Urology. 2000 Feb; 55(2): 231-5
34. Kupeli,-S; Soygur,-T; Yilmaz,-E, et al. Combined transurethal resection and vaporization of the prostate using newly designed electrode: a promising treatment alternative for benign prostatic hyperplasia.J-Endourol. 1999 Apr; 13(3): 225-8
35. Dushinski,-J-W; Lingeman,-J-E. Urologic applications of the Holmium laser.Tech-Urol. 1997 Summer; 3(2): 60-4.
36. Erhard,-M-J; Bagley,-D-H. Urologic applications of the holmium laser: preliminary experience. J-Endourol. 1995 Oct; 9(5): 383-6.
37. Gilling,-P-J; Cass,-C-B; Cresswell,-M-D, et al. The use of the holmium laser in the treatment of benign prostatic hyperplasia. J-Endourol. 1996 Oct; 10(5): 459-61.
Gilling,-P-J; Kennett,-K; Das,-A-K, et al. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early
38. clinical experience. J-Endourol. 1998 Oct; 12(5): 457-9.
39. Moody,-J-A; Lingeman,-J-E. Holmium laser enucleation of the prostate with tissue morcellation: initial United States experience. J-Endourol. 2000 Mar; 14(2): 219-23.
40. Gilling,-P-J; Kennett,-K-M; Fraundorfer,-M-R,et al. Holmium laser resection v transurethral resection of the prostate: results of a randomized trial with 2 years of follow-up. J-Endourol. 2000 Nov; 14(9): 757-60.
41. Bakan,-N; Gedik,-E; Ersoy,-O. Early detection of the TURP syndrome. Anesth-Analg. 2000 Jul; 91(1): 250-1
42. Jensen,-V. The TURP syndrome.Can-J-Anaesth. 1991 Jan; 38(1): 90-6
43. Le-Duc,-A; Gilling,-P-J .Holmium laser resection of the prostate. Eur-Urol. 1999 Feb; 35(2): 155-60.
44. Gravenstein,-D. Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management.Anesth-Analg. 1997 Feb; 84(2): 438-46
45. Moody,-J-A; Lingeman,-J-E. Holmium laser enucleation for prostate adenoma greater than 100 gm.: comparison to open prostatectomy. J-Urol. 2001 Feb; 165(2): 459-62.
2. Yamamoto,-M; Hibi,-H; Miyake,-K. A comparison of transurethral resection of the prostate and medical treatment for the patient with moderate symptoms of benign prostatic hyperplasia.Nagoya-J-Med-Sci. 1996 Mar; 59(1-2): 11-6
3. Manyak,-M-J; Aulisi,-G-P. Free-beam and contact laser ablation of benign prostatic hyperplasia with the KTP/Nd:YAG laser: efficacy and versatility.World-J-Urol. 1995; 13(2): 104-8
4. Narayan,-P; Fournier,-G; Indudhara,-R, et al. Transurethral evaporation of prostate (TUEP) with Nd:YAG laser using a contact free beam technique: results in 61 patients with benign prostatic hyperplasia.Urology. 1994 Jun; 43(6): 813-20
5. Jung,-P; Mattelaer,-P; Wolff,-J-M, et al. Visual laser ablation of the prostate: efficacy evaluated by urodynamics and compared to TURP.Eur-Urol. 1996; 30(4): 418-23
6. Tuhkanen,-K; Heino,-A; Ala-Opas,-M. Contact laser prostatectomy compared to TURP in prostatic hyperplasia smaller than 40 ml. Six-month follow-up with complex urodynamic assessment.Scand-J-Urol-Nephrol. 1999 Feb; 33(1): 31-4
7. Costello,-A-J; Crowe,-H-R; Jackson,-T, et al. A randomised single institution study comparing laser prostatectomy and transurethral resection of the prostate.Ann-Acad-Med-Singapore. 1995 Sep; 24(5): 700-4
8. Anson,-K; Nawrocki,-J; Buckley,-J, et al. A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate. Urology. 1995 Sep; 46(3): 305-10
9. Delvecchio,-F-C; Preminger,-G-M Curr-Opin -Urol. Endoscopic management of urologic disease with the holmium laser. 2000 May; 10(3): 233-7.
10. Gilling,-P-J; Cass,-C-B; Cresswell,-M-D, et al. The use of the holmium laser in the treatment of benign prostatic hyperplasia.J-Endourol. 1996 Oct; 10(5): 459-61
11. Gilling,-P-J; Cass,-C-B; Cresswell,-M-D, et al. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia.Urology. 1996 Jan; 47(1): 48-51
12. Kubba,-A-K; Greig,-J-D; Wallace,-I-W. Transurethral resection of the prostate in 539 patients at a district general hospital.J-R-Coll-Surg-Edinb. 1995 Aug; 40(4): 240-2
13. Koshiba,-K; Egawa,-S; Ohori,-M, et al. Does transurethral resection of the prostate pose a risk to life? 22-year outcome.J-Urol. 1995 May; 153(5): 1506-9
14. Bartoloni,-A; Gottin,-L; Ficarra,-V, et al. The TURP syndrome: importance of expiratory ethanol measurement and high serum levels of glycine.Arch-Esp-Urol. 2001 Jun; 54(5): 480-7
15. Paul,-A-B; Chisholm,-G-D. How dangerous is TURP?J-R-Coll-Surg-Edinb. 1993 Dec; 38(6): 333-4
16. Trepanier,-C-A; Lessard,-M-R; Brochu,-J, et al. Another feature of TURP syndrome: hyperglycaemia and lactic acidosis caused by massive absorption of sorbitol. Br-J-Anaesth. 2001 Aug; 87(2): 316-9
17. Mazur,-A-W; Thompson,-I-M. Efficacy and morbidity of "channel" TURP.Urology. 1991 Dec; 38(6): 526-8
18. Yeoh,-N; Inbasegaran,-K. A personal experience with the first 100 TURP at the Penang General Hospital.Med-J-Malaysia. 1989 Jun; 44(2): 129-33
19. Littlejohn,-Joe-O Jr; Ghafar,-Mohamed-A; Kang,-Young-M, et al. Transurethral resection of the prostate: the new old standard.Curr-Opin-Urol. 2002 Jan; 12(1): 19-23
20. Te,-A-E; Reis,-R; Kaplan,-S-A. TVP: a new modification of TURP.Contemp-Urol. 1995 May; 7(5): 74-8, 81-3
21. Patel,-A; Fuchs,-G-J; Gutierrez-Aceves,-J, et al. Transurethral electrovaporization and vapour-resection of the prostate: an appraisal of possible electrosurgical alternatives to regular loop resection.BJU-Int. 2000 Jan; 85(2): 202-10
22. Talic,-R-F; Al-Rikabi,-A-C. Transurethral vaporization-resection of the prostate versus standard transurethral prostatectomy: comparative changes in histopathological features of the resected specimens.Eur-Urol. 2000 Mar; 37(3): 301-5
23. Netto,-N-R Jr; De-Lima,-M-L; Lucena,-R, et al. Is transurethral vaporization a remake of transurethral resection of the prostate? J-Endourol. 1999 Oct; 13(8): 591-4
24. Zhou,-Z; Wang,-Z; Chen,-C, et al. Transurethral prostate vaporization using an oval electrode in 82 cases of benign prostatic hyperplasia. Chin-Med-J-(Engl). 1998 Jan; 111(1): 52-5
25. Aytac,-S; Yilmaz,-E; Budak,-M. Kupeli,-S; Baltaci,-S; Soygur,-T, et al. A prospective randomized study of transurethral resection of the prostate and transurethral vaporization of the prostate as a therapeutic alternative in the management of men with BPH.Eur-Urol. 1998; 34(1): 15-8
26. Gerber,-G-S; Jahoda,-A; Bales,-G-T, et al. Transurethral vaporization of the prostate in the treatment of bladder outlet obstruction at two university hospitals.Tech-Urol. 1997 Spring; 3(1): 25-9
27. Dimitri,-M. TURP with the new superpulsed radiofrequency energy: More than a gold standard.Eur-Urol. 1999 Oct; 36(4): 331-4
28. Faul,-P; Farin,-G; Reich,-O, et al. The 'band electrode': first experiences with a novel TURP procedure to improve hemostasis. Eur-Urol. 1996; 30(3): 403-8
29. Talic,-R-F; Al-Kudair,-W-K; El-Tiraifi,-A-E, et al. The 'Wing' versus the 'Vapor Cut' electrodes in transurethral electrovaporization- resection of the prostate: comparative changes in safety parameters.Urol-Int. 2000; 65(2): 95-9
30. Hammadeh,-M-Y; Madaan,-S; Singh,-M, et al. A 3-year follow-up of a prospective randomized trial comparing transurethral electrovaporization of the prostate with standard transurethral prostatectomy.BJU-Int. 2000 Oct; 86(6): 648-51
31. Talic,-R-F; El-Tiraifi,-A; El-Faqih,-S-R, et al. Prospective randomized study of transurethral vaporization resection of the prostate using the thick loop and standard transurethral prostatectomy.Urology. 2000 Jun; 55(6): 886-90; discussion 890-1
32. Kupeli,-S; Yilmaz,-E; Soygur,-T, et al. Randomized study of transurethral resection of the prostate and combined transurethral resection and vaporization of the prostate as a therapeutic alternative in men with benign prostatic hyperplasia.J-Endourol. 2001 Apr; 15(3): 317-21
33. Ekengren,-J; Haendler,-L; Hahn,-R-G. Clinical outcome 1 year after transurethral vaporization and resection of the prostate.Urology. 2000 Feb; 55(2): 231-5
34. Kupeli,-S; Soygur,-T; Yilmaz,-E, et al. Combined transurethal resection and vaporization of the prostate using newly designed electrode: a promising treatment alternative for benign prostatic hyperplasia.J-Endourol. 1999 Apr; 13(3): 225-8
35. Dushinski,-J-W; Lingeman,-J-E. Urologic applications of the Holmium laser.Tech-Urol. 1997 Summer; 3(2): 60-4.
36. Erhard,-M-J; Bagley,-D-H. Urologic applications of the holmium laser: preliminary experience. J-Endourol. 1995 Oct; 9(5): 383-6.
37. Gilling,-P-J; Cass,-C-B; Cresswell,-M-D, et al. The use of the holmium laser in the treatment of benign prostatic hyperplasia. J-Endourol. 1996 Oct; 10(5): 459-61.
Gilling,-P-J; Kennett,-K; Das,-A-K, et al. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early
38. clinical experience. J-Endourol. 1998 Oct; 12(5): 457-9.
39. Moody,-J-A; Lingeman,-J-E. Holmium laser enucleation of the prostate with tissue morcellation: initial United States experience. J-Endourol. 2000 Mar; 14(2): 219-23.
40. Gilling,-P-J; Kennett,-K-M; Fraundorfer,-M-R,et al. Holmium laser resection v transurethral resection of the prostate: results of a randomized trial with 2 years of follow-up. J-Endourol. 2000 Nov; 14(9): 757-60.
41. Bakan,-N; Gedik,-E; Ersoy,-O. Early detection of the TURP syndrome. Anesth-Analg. 2000 Jul; 91(1): 250-1
42. Jensen,-V. The TURP syndrome.Can-J-Anaesth. 1991 Jan; 38(1): 90-6
43. Le-Duc,-A; Gilling,-P-J .Holmium laser resection of the prostate. Eur-Urol. 1999 Feb; 35(2): 155-60.
44. Gravenstein,-D. Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management.Anesth-Analg. 1997 Feb; 84(2): 438-46
45. Moody,-J-A; Lingeman,-J-E. Holmium laser enucleation for prostate adenoma greater than 100 gm.: comparison to open prostatectomy. J-Urol. 2001 Feb; 165(2): 459-62.