{"id":19074,"date":"2026-09-28T14:20:28","date_gmt":"2026-09-28T12:20:28","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=19074"},"modified":"2026-09-28T14:20:49","modified_gmt":"2026-09-28T12:20:49","slug":"management-chirurgical-modern-al-adenomului-de-prostata-holep-vs-tur-p","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/management-chirurgical-modern-al-adenomului-de-prostata-holep-vs-tur-p\/","title":{"rendered":"Management chirurgical modern al adenomului de prostat\u0103: HoLEP vs. TUR-P"},"content":{"rendered":"<p style=\"text-align: justify;\">Rezec\u021bia transuretral\u0103 a prostatei (TUR-P) r\u0103m\u00e2ne una dintre cele mai frecvent efectuate interven\u021bii \u00een practica urologic\u0103 general\u0103 \u0219i a reprezentat, timp de decenii, standardul de referin\u021b\u0103 (\u201egold standard\u201d) \u00een managementul hiperplaziei benigne de prostat\u0103 (HBP) cu indica\u021bie chirurgical\u0103. Procedura este larg disponibil\u0103, bine standardizat\u0103 \u0219i asociat\u0103 cu rezultate func\u021bionale favorabile pe termen mediu \u0219i lung. Cu toate acestea, evolu\u021bia tehnologiilor minim invazive ridic\u0103 \u00eentrebarea dac\u0103 TUR-P \u00ee\u0219i mai men\u021bine acest statut \u00een prezent.<\/p>\n<p style=\"text-align: justify;\">Enucleerea prostatic\u0103 cu laser Holmium (HoLEP \u2013 <em>Holmium Laser Enucleation of the Prostate<\/em>) reprezint\u0103 o alternativ\u0103 modern\u0103, tot mai utilizat\u0103, \u00een special \u00een centrele din Europa de Vest. Procedura const\u0103 \u00een enucleerea complet\u0103 a \u021besutului adenomatos de la nivelul capsulei prostatice cu ajutorul unui laser de \u00eenalt\u0103 energie, urmat\u0103 de morcelarea \u0219i evacuarea acestuia.<\/p>\n<p style=\"text-align: justify;\">At\u00e2t TUR-P, c\u00e2t \u0219i HoLEP sunt tehnici minim invazive realizate pe cale transuretral\u0103, \u00eens\u0103 difer\u0103 fundamental prin principiul chirurgical. TUR-P presupune rezec\u021bia fragmentar\u0103 a \u021besutului prostatic, ceea ce poate conduce la o \u00eendep\u0103rtare incomplet\u0103 a adenomului. \u00cen schimb, HoLEP se bazeaz\u0103 pe enucleerea anatomic\u0103 complet\u0103 a acestuia, similar\u0103 adenomectomiei deschise, dar realizat\u0103 endoscopic.<\/p>\n<p style=\"text-align: justify;\">Aceast\u0103 diferen\u021b\u0103 se reflect\u0103 \u00een rezultatele clinice. HoLEP permite \u00eendep\u0103rtarea unui volum mai mare de \u021besut prostatic, ceea ce se coreleaz\u0103 cu o ameliorare mai semnificativ\u0103 a parametrilor func\u021bionali urinari (debit urinar maxim, scor IPSS, reziduu postmic\u021bional) \u0219i cu o durabilitate crescut\u0103 a rezultatelor. \u00cen consecin\u021b\u0103, rata de reinterven\u021bie este mai redus\u0103 comparativ cu TUR-P, iar necesitatea relu\u0103rii tratamentului medicamentos este minim\u0103.<\/p>\n<p style=\"text-align: justify;\">Din punct de vedere al siguran\u021bei, HoLEP ofer\u0103 avantaje importante datorit\u0103 efectului hemostatic al laserului Holmium, care permite coagularea eficient\u0103 a vaselor la nivel capsular. Acest lucru se traduce prin pierderi sanguine reduse, rate mai mici de transfuzie \u0219i posibilitatea utiliz\u0103rii procedurii la pacien\u021bi cu risc hemoragic crescut sau afla\u021bi sub tratament anticoagulant\/antiagregant, \u00een condi\u021bii atent selec\u021bionate.<\/p>\n<p style=\"text-align: justify;\">Un alt element diferen\u021biator major \u00eel reprezint\u0103 volumul prostatic tratabil. TUR-P este, \u00een general, indicat\u0103 pentru prostate cu volum sub 70\u201380 ml, \u00een timp ce HoLEP nu prezint\u0103 limit\u0103ri semnificative legate de dimensiune, fiind eficient\u0103 \u0219i \u00een cazul adenoamelor voluminoase (&gt;100\u2013150 ml). \u00cen acest context, HoLEP poate \u00eenlocui cu succes prostatectomia simpl\u0103 deschis\u0103 sau prin abord laparoscopic\/robotic.<\/p>\n<p style=\"text-align: justify;\">\u00cen plus, tehnologia laser permite tratarea concomitent\u0103 a litiazei vezicale, frecvent asociat\u0103 obstruc\u021biei cronice determinate de HBP.<\/p>\n<p style=\"text-align: justify;\">\u00cen concluzie, de\u0219i TUR-P \u00ee\u0219i p\u0103streaz\u0103 un rol important \u00een practica curent\u0103, HoLEP se contureaz\u0103 tot mai clar ca tehnic\u0103 de elec\u021bie \u00een tratamentul chirurgical al hiperplaziei benigne de prostat\u0103, datorit\u0103 eficacit\u0103\u021bii superioare, durabilit\u0103\u021bii rezultatelor, profilului de siguran\u021b\u0103 favorabil \u0219i aplicabilit\u0103\u021bii independente de volumul prostatic.<\/p>\n<p>Autor: Dr. Alexandru Mihalache, Medic Primar Urologie &#8211; Clinica Medikali<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Rezec\u021bia transuretral\u0103 a prostatei (TUR-P) r\u0103m\u00e2ne una dintre cele mai frecvent efectuate interven\u021bii \u00een practica urologic\u0103 general\u0103 \u0219i a reprezentat, timp de decenii, standardul de referin\u021b\u0103 (\u201egold standard\u201d) \u00een managementul [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":19076,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[154],"tags":[],"class_list":["post-19074","post","type-post","status-publish","format-standard","has-post-thumbnail","category-urologie"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - 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