INTRODUCTION Holmium laser enucleation of the prostate (HoLEP) is routinely performed with a 24, 26, or a 28 French (F) scope. Proponents of the larger scopes propose that a bigger sheath size allows for superior flow and visibility leading to a more efficient operation and better hemostasis. Those utilizing the smaller scopes suggest the lower profile is less traumatic, resulting in lower stricture rates and temporary incontinence. We sought to compare outcomes of ambulatory HoLEP using the 24F and 28F laser scope. MATERIALS AND METHODS From May 2022 to March 2023, we randomized patients undergoing HoLEP (<200 cm3 in size) 1:1 to either a 24F or 28F scope. The primary outcome was differences in surgical duration between groups (mins). Secondary outcomes included surgeon scope evaluation and post-operative patient results. RESULTS There was no difference in patient characteristics in those randomized to 28F (n=76) versus 24F (n=76) (p>0.05) scopes. Procedural duration and efficiencies were not different between groups (all p>0.05). The 28F scope was associated with improved surgeon-graded irrigation flow and visibility (p<0.001). Patients treated with the 28F scope were more likely to achieve successful same-day trial of void (28F 94.3% vs. 24F 82.1%, p=0.048) and have a shorter length of stay (28F 7.0 vs. 24F 11.9 hours, p=0.014), however rates of same-day discharge were not statistically different (28F 87.8% vs. 24F 78.4%, p=0.126). There was no difference between the cohorts in rates of 90-day emergency room presentations, re-admissions, complications, or functional ouctomes (p>0.05). CONCLUSIONS We identified no clear advantage of scope size with regards to intra-operative or post-operative outcomes at 3-month follow up due to scope size. However, if same-day discharge is part of your postoperative pathway, the 28F scope may shorten length of stay and increase rates of successful same-day trial of void.

中文翻译：

---

电切镜鞘尺寸是否会影响钬激光前列腺剜除术 (HoLEP) 的结果？前瞻性随机对照试验。

简介 钬激光前列腺剜除术 (HoLEP) 通常使用 24、26 或 28 法国 (F) 示波器进行。更大内窥镜的支持者提出，更大的护套尺寸可以提供更好的流动性和可视性，从而实现更高效的操作和更好的止血。使用较小内窥镜的人表明，较小的内窥镜造成的创伤较小，从而降低了狭窄率和暂时性失禁。我们试图比较使用 24F 和 28F 激光范围的动态 HoLEP 的结果。材料和方法 从 2022 年 5 月到 2023 年 3 月，我们将接受 HoLEP（尺寸 <200 cm3）的患者以 1:1 的比例随机分配至 24F 或 28F 镜组。主要结果是组间手术持续时间（分钟）的差异。次要结局包括外科医生范围评估和术后患者结果。结果 随机分配到 28F (n=76) 与 24F (n=76) 范围的患者特征没有差异 (p>0.05)。各组之间的手术持续时间和效率没有差异（均 p>0.05）。28F 镜与外科医生分级冲洗流量和能见度的改善相关（p<0.001）。使用 28F 镜治疗的患者更有可能成功当天尝试无效（28F 94.3% 对比 24F 82.1%，p=0.048），并且住院时间更短（28F 7.0 对比 24F 11.9 小时，p= 0.014），但当天出院率没有统计学差异（28F 87.8% vs. 24F 78.4%，p=0.126）。各队列之间的 90 天急诊室就诊率、再次入院率、并发症率或功能结果没有差异 (p>0.05)。结论 我们发现，由于内窥镜尺寸的原因，在术中或术后 3 个月随访结果方面，内窥镜尺寸没有明显的优势。然而，如果当天出院是您术后路径的一部分，28F 内窥镜可能会缩短住院时间并提高当天排空试验的成功率。