Photoselective laser vaporization prostatectomy for acute urinary retention in China

PURPOSE: To assess the clinical efficacy and safety of photoselective laser vaporization of the prostate (PVP) in the treatment of patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Forty-two patients (mean age 72 +/- 5 years, range 65-89) with AUR because of BPH were treated with a prospective trial of PVP with the potassium-titanyl-phosphate (KTP) laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), disease-specific quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The International Index of Erectile Function questionnaire and a self-designed ejaculatory questionnaire were completed at different follow-up times to determine patient satisfaction and changes in sexual function. RESULTS: After preliminary urine drainage and adequate preoperative preparation, PVP was performed and bladder outlet obstruction was effectively relieved. The mean prostate volume was 62.5 +/- 11.7 cc, and the mean residual volume with retention was 650 mL (range 240-1200 mL). Mean operative time was 28.6 +/- 5.7 minutes. Mean catheterization duration was 5.6 days (range 3-14 d). There was significant subjective improvement of symptoms and objective improvement in urinary flow rates at 12 months. The mean IPSS and QoL score decreased significantly (P < 0.05). Mean PVR volume also decreased. The mean Qmax was 16.2 +/- 4.6 mL/sec after treatment. Only two patients had recurrent urinary retention during follow-up. There were no intraoperative or postoperative adverse events. CONCLUSIONS: The early clinical results suggest that the PVP is a promising safe, effective, and less-invasive treatment with minimal morbidity for patients with urine retention secondary to BPH.     

经尿道选择性绿激光汽化术与前列腺汽化电切除术治疗良性前列腺增生的疗效比较

目的 比较经尿道选择性绿激光前列腺汽化术（PVP）与前列腺汽化电切除术（TUVP）治疗良性前列腺增生（BPH）的安全性及疗效。方法 随机采用PVP与TUVP两种手术方式治疗BPH患者163例,其中PVP组105例,TUVP组58例。对两组患者的国际前列腺症状评分（IPSS）、生活质量评分（QOL）、术中出血量、手术时间、冲洗液清亮时间、留置尿管时间、最大尿流率、术后并发症等进行比较。结果 两组手术前后IPSS、QOL、Qmax、剩余尿量（RUV）比较均显著改善（P〈0．05）,但两组之间症状改善差异无统计学意义（P〉0．05）。TUVP组手术时间平均（37±15）min,PVP组则为平均（45±28）min,TUVP手术操作时间少于PVP,但差异无统计学意义（P〉0．05）。PVP组术中出血量少、拔除尿管早,优于TUVP组（P〈0,05）。术后随访6个月两组前列腺症状评分及最大尿流率疗效相同。TUVP组术后血尿明显（41．4％）,需膀胱冲洗,而PVP术后尿路刺激症状明显（55．2％,P〈0．05）。结论 PVP手术是一种手术过程非常安全、并发症少,能达到与TUVP完全相同治疗效果的手术方式。     

Photoselective KTP laser vaporization of the prostate: first experiences with 65 procedures

PURPOSE: To study the feasibility and efficacy of 80 W potassium-titanyl-phosphate (KTP) laser vaporization (GreenLight PV; Laserscope) of the prostate in patients suffering from voiding dysfunction secondary to benign prostatic hyperplasia (BPH) or known locally advanced prostate cancer (CaP). PATIENTS AND METHODS: Sixty-five patients with symptomatic BPH (N=57) or obstructive voiding secondary to CaP (N=8) with a mean age of 70 +/- 10 years (range 46-93 years) underwent photoselective 80 W KTP laser vaporization of the prostate. All consecutive patients, including 34 with a history of chronic urinary retention or indwelling catheter, were enrolled. Prostate specific antigen (PSA) values, prostate volume as measured by transrectal ultrasonography, urinary peak flow measurement (Qmax), postvoiding residual volume (PVR) measured transvesically, and International Prostate Symptom Score (IPSS) were assessed preoperatively, on the day of discharge, and 1 month and 3 months postoperatively. The mean preoperative prostate volume was 49 +/- 32 cc (range 15-250 cc). RESULTS: In all 65 patients, KTP laser vaporization was performed successfully, with a mean operating time of 57 +/- 25 minutes (range 10-160 minutes). No major complication occurred intraoperatively or postoperatively, and no transfusions were necessary. All patients were catheter free after 1 month. At 1 month and 3 months, the urinary peak flow had increased from 7.7 +/- 2.8 mL/sec preoperatively to 20.9 +/- 11.6 mL/sec (+171%) and 18.2 +/- 6.3 mL/sec (+136%), respectively. The IPSS decreased from 18.5 +/- 6.7 to 9.2 +/- 7.7 (-50%) and 7.2 +/- 5.9 (-61%) at 1 and 3 months, respectively. CONCLUSIONS: A 80 W KTP laser vaporization of the prostate technique instantly removes obstructive tissue. A transurethral resection-like visible cavity is the endpoint. Immediate symptom relief is achieved in a truly minimally invasive way with a very low postoperative complication rate within 3 months' follow-up.     

Photoselective laser vaporization of the prostate in the treatment of bladder outlet obstruction in advanced-stage prostate cancer: a single-center experience

Abstract Background and Purpose: The study in China is the first on photoselective vaporization of the prostate (PVP) applied to bladder outlet obstruction (BOO) or urinary retention from advanced-stage prostate cancer (PCa). The aim is to evaluate the efficacy and safety of PVP in the treatment of patients with BOO secondary to advanced-stage PCa. Patients and Methods: Forty-five patients (mean age 76.13±5.88 years, range 62-89 years) with BOO or urinary retention secondary to advanced-stage PCa received PVP with a potassium-titanyl-phosphate laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The operative time, indwelling catheterization time, and operative complications were also observed. Results: All 45 patients recovered without incident. The mean operative time was 50±7.6 minutes. The catheterization duration was 3.2 days (range 2-7 days). There was significant improvement in Qmax from 7.29±0.93 to 12.16±2.75?mL/sec after treatment at 12 months. Mean PVR volume decreased from 210.94±179.49 to 54.45±33.16?mL. Mean IPSS score decreased from preoperative 28.19±3.64 to postoperative 14.61±2.81 (P<0.05), QoL score decreased from 5.03±0.69 to 3.66±0.65 (P<0.05). There were no intraoperative adverse events. Postoperative complications included mild transient hematuria in 12 (26.7%) patients and mild dysuria in 11 (24.4%) patients within 4 weeks. Conclusions: The clinical results suggest that PVP is a safe, efficient, and less-invasive treatment for patients with BOO or urinary retention secondary to advanced-stage PCa.     

Transurethral resection (TUR) in saline plasma vaporization of the prostate vs standard TUR of the prostate: ‘the better choice’ in benign prostatic hyperplasia?

Study Type – Therapy (RCT)
Level of Evidence 1b

OBJECTIVE

To evaluate the efficiency, safety and short‐term outcome of transurethral resection in saline plasma vaporization of the prostate (TURis‐PVP), and to compare it to the standard TUR of the prostate (TURP).

PATIENTS AND METHODS

In all, 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), with a maximum urinary flow rate (Q_max) of <10 mL/s, an International Prostate Symptom Score (IPSS) of >19 and prostate volume of 30–80 mL were enrolled in this prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, health‐related quality of life (HRQL) score, Q_max and postvoid residual urine volume (PVR).

RESULTS

Patients from both series had similar preoperative characteristics. TURis‐PVP and TURP were successfully performed in all cases (75 and 80, respectively). The operative duration, catheterization period and hospital stay were significantly shorter for TURis‐PVP patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and 47.6 vs 93.1 h, respectively (all P < 0.05). At the 1, 3 and 6 months follow‐ups, improvements in the variables measured were better in the TURis‐PVP group: the IPSS was 4.4 vs 8.3 and the Q_max was 22.7 vs 20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6 and the Q_max was 22.3 vs 20.0 mL/s at 3 months; and the IPSS was 5 vs 9.1 and the Q_max was 21.8 vs 19.3 mL/s at 6 months (All P < 0.05).

CONCLUSIONS

TURis‐PVP represents a valuable endoscopic treatment alternative for patients with BPE, with superior efficacy, short‐term results and complication rates compared with monopolar TURP.     

Rapid communication: photoselective vaporization of the prostate versus transurethral resection of the prostate for the large prostate: a prospective nonrandomized bicenter trial with 2-year follow-up

PURPOSE: To present our 2-year data comparing photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP) for patients suffering from lower urinary tract symptoms (LUTS) secondary to large-volume benign prostatic hyperplasia. MATERIALS AND METHODS: In this prospective, nonrandomized study, 81 patients with a prostate volume of between 70 and 150 mL underwent either PVP (40) or TURP (41). All patients were preoperatively assessed by International Prostate Symptom Score (IPSS), transrectal ultrasonography (TRUS), uroflowmetry, and postvoid residual urine (PVR) measurement. We compared parameters, complications, and functional follow-up between the groups. RESULTS: The baseline characteristics of the two groups were similar. Mean operative time was 126.2 +/- 17.4 minutes for PVP and 77.9 +/- 8.3 minutes for TURP (P < 0.001). Bleeding requiring blood transfusion in one patient and transurethral resection (TUR) syndrome in one patient were observed in the TURP group. Catheter indwelling times and hospitalization times of patients in the PVP group were all shorter than those of patients in the TURP group (P < 0.001). In both the groups, an immediate and highly significant improvement of maximum urinary flow rate (Q(max)), PVR, and IPSS was evident. Capsule perforation was observed in one patient undergoing TURP. Reoperation was required in three patients in the group of PVP and one patient in the TURP group. We observed urethral stricture in two patients after TURP. CONCLUSION: The postoperative micturition improvement was significant and lasting, and was equivalent in both groups. The rate of late complications is equally low with both procedures. Catheterization time and hospital stay were significantly shorter with PVP.     

钬激光前列腺剜除术与电切术安全性及疗效比较

目的 比较并探讨钬激光前列腺剜除术(HoLEP)和传统经尿道前列腺电切术(TURP)的安全性及疗效,旨在为良性前列腺增生症的临床治疗提供理论依据.方法 回顾性分析哈尔滨医科大学附属第四医院2015年1月-2016年1月收治的349例良性前列腺增生症患者的病例资料,并将其随机分成两组.其中172例患者选择行钬激光前列腺剜除术,另外177例患者选择行传统经尿道前列腺电切术.比较两组患者术中出血量、手术时间、术后导尿管留置时间、术后住院天数以及术后并发症(尿失禁、膀胱痉挛、出血)的发病率.随访3个月,重新评估IPSS、QOL、Qmax指标并比较疗效.结果 与传统经尿道前列腺电切术组相比,钬激光前列腺剜除术组患者的手术时间明显缩短、术中出血量及术后住院天数显著降低(P＜0.05),术后导尿管留置时间[钬激光前列腺剜除术组:(2.4±0.5)d;传统经尿道前列腺电切术组:(5.7±0.6)d,P＜0.05].明显减少,术中切除前列腺重量明显增加,术后并发症的发病率[钬激光前列腺剜除术组:5/172(2.9％);传统经尿道前列腺电切术组:19/177(10.7％),P＜0.01]显著下降.3个月后,两组术后PVR、IPSS、QOL以及Qmax较术前相比明显改善(P＜0.01),组间比较差异无统计学意义(P＞0.05).结论 钬激光前列腺剜除术与传统经尿道前列腺电切术相比疗效相当,但安全性更高.钬激光前列腺剜除术治疗临床前列腺增生症具有重要意义.     

GreenLight laser vaporization of the prostate: single-center experience and long-term results after 500 procedures

BACKGROUND: Long-term data of photoselective vaporization of the prostate (PVP) for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is scanty. OBJECTIVE: Evaluate the long-term efficacy and the complication rate in 80-watt (W) PVP. DESIGN, SETTING, AND PARTICIPANTS: 500 consecutive patients with LUTS secondary to BPH underwent PVP between September 2002 and April 2007. The mean follow-up was 30.6+/-16.6 (5.2-60.6) mo. INTERVENTION: All patients underwent 80-W PVP performed by seven surgeons. MEASUREMENTS: We evaluated perioperative parameters, including operation time, delivered energy, changes of hemoglobin and serum sodium, catheterization, and hospitalization time as well as intraoperative and postoperative complications. Patients presenting for follow-up had data assessed on the International Prostate Symptom Score and quality-of-life questionnaire (IPPS-QoL), maximal flow rate (Q(max)), and post-voiding residual volume (Vres). RESULTS AND LIMITATIONS: Mean patient age was 71.4+/-9.6 (46-96) yr, with a mean preoperative prostate volume of 56.1+/-25.3 (10-180) ml. Mean operation time was 66.4+/-26.8 (10-160) min, and mean energy delivery was 206+/-94 (2.4-619.0) kJ. Despite ongoing oral anticoagulation in 45% of the patients (n=225), no severe intraoperative complications were observed. Mean catheterization and postoperative hospitalization time was 1.8+/-1.2 (0-10) and 3.7+/-2.9 (0-35) d, respectively. The mean IPSS after 3 yr was 8.0+/-6.2, the QoL score was 1.3+/-1.3, the Q(max) was 18.4+/-8.0ml/s, and the Vres was 28+/-42ml. The retreatment rate was 6.8%. Urethral and bladder neck strictures were observed in 4.4% and 3.6% of the patients, respectively. Localized prostate cancer was diagnosed during follow-up in six patients. CONCLUSION: PVP is a safe and effective procedure for treatment of LUTS secondary to BPH. Patients on ongoing oral anticoagulation can be safely operated on. PVP leads to an immediate and sustained improvement of subjective and objective voiding parameters. The late complication rate is comparable to that of transurethral electroresection of the prostate.     

Significant relationship of time-dependent uroflowmetric parameters to lower urinary tract symptoms as measured by the International Prostate Symptom Score

AIMS: The aim of the present paper is to elucidate the possible involvement of time-dependent parameters as obtained by uroflowmetry in the manifestation of lower urinary tract symptoms (LUTS) in elderly patients. METHODS: Using simple and multiple regression analyses, the correlation of the International Prostate Symptom Score (IPSS) with objective parameters including age, postvoid residual, uroflowmetry and transrectal ultrasonic measurements of the prostate was analyzed in 206 male patients (average age of 68.0 +/- 7.4 years) who visited our outpatient clinic complaining of LUTS. RESULTS: In the 206 patients, the mean maximum flow rate was 12.2 mL/s (13.7 mL/s in mild, 11.9 mL/s in moderate, and 11.2 mL/s in severe IPSS total score) and average flow rate was 4.4 mL/s (5.4 mL/s in mild, 4.3 mL/s in moderate, and 3.5 mL/s in severe IPSS total score). Simple regression analyses demonstrated that age, voiding time, and average and maximum flow rates correlate significantly with symptom scores. In particular, relatively strong relationships were found between average flow rate and scores of intermittency, weak stream and total and voiding symptoms scores. Serum prostate specific antigen level, postvoid residual and prostatic ultrasonic measurements did not show a significant correlation with symptom scores. Multiple regression analyses revealed age and average flow rate to be independent determinants for symptom scores. These results suggest that the time-dependent function in micturition interferes in the manifestation of LUTS in elderly men who have borderline or pathologic maximum flow rate. When evaluating uro flowmetry in elderly male patients with LUTS, attention should be paid to time-dependent parameters such as voiding time and average flow rate.     

Photoselective green-light laser vaporisation vs. TURP for BPH: meta-analysis

This study sought to evaluate the efficacy and safety of photoselective vaporisation (PVP) vs. transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH). Eligible studies were identified from electronic databases (Cochrane Library, PubMed and EMBASE). The database search, quality assessment and data extraction were performed independently by two reviewers. Efficacy (primary outcomes: maximum urinary flow rate (Q_max), international prostate symptom score (IPSS), postvoid residual urine (PVR) and quality of life (QoL); secondary outcomes: operative time, hospital time and catheter removal time) and safety (complications, such as transfusion and capsular perforation) were explored by using Review Manager 5.0. Six randomized controlled trials (RCTs) and five case-controlled studies of 1398 patients met the inclusion criteria. A meta-analysis of the extractable data showed that there were no differences in IPSS, Q_max, QoL or PVR between PVP and TURP (mean difference (MD): prostate sizes <70 ml, Q_max at 24 months, MD=0.01, P=0.97; IPSS at 12 months, MD=0.18, P=0.64; QoL at 12 months, MD=−0.00, P=0.96; PVR at 12 months, MD=0.52, P=0.43; prostate sizes >70 ml, Q_max at 6 months, MD=−3.46, P=0.33; IPSS at 6 months, MD=3.11, P=0.36; PVR at 6 months, MD=25.50, P=0.39). PVP was associated with a shorter hospital time and catheter removal time than TURP, whereas PVP resulted in a longer operative time than TURP. For prostate sizes <70 ml, there were fewer transfusions, capsular perforations, incidences of TUR syndrome and clot retentions following PVP compared with TURP. These results indicate that PVP is as effective and safe as TURP for BPH at the mid-term patient follow-up, in particular for prostate sizes <70 ml. Due to the different energy settings available for green-light laser sources and the higher efficiency and performance of higher-quality lasers, large-sample, long-term RCTs are required to verify whether different energy settings affect outcomes.     

高功率绿激光治疗高龄高危前列腺疾病的疗效评价

目的探讨120W高功率绿激光选择性前列腺汽化术（HPS PVP）治疗高危前列腺疾病的疗效及安全性。方法对31例高危前列腺疾病患者进行HPS PVP。其中前列腺增生24例,前列腺癌7例。对手术时间、出血量、光纤能量消耗、术后留置导尿时间、并发症、最大尿流率、IPSS、QOL、残余尿等指标进行评价。结果 29例顺利完成手术。手术时间30～85min,平均（43±18.4）min。术中出血20～50mL,平均（26±10.7）mL。无输血病例。术中光纤能量平均消耗（247±38.1）kJ。术后留置导尿管时间24～96h,平均（38.8±15.1）h。无尿失禁、继发性出血、急性尿潴留再次手术病例。术后1月最大尿流率由术前平均（5.2±2.7）mL/s提高到（15.3±4.8）mL/s。IPSS评分由术前平均（24.4±3.2）减少到（7.8±2.5）。QOL由术前平均（5.1±0.3）减少到（2.5±0.2）。残余尿量由术前平均（251.3±38.8）mL减少到术后（32.5±9.2）mL。手术前后差异均有统计学意义（P〈0.05）。结论 120W高功率PVP治疗高龄高危前列腺疾病患者,具有手术时间短,出血少,安全性高,术后并发症少,留置导尿管时间短等优点。不仅可作为高龄高危良性前列腺增生患者,也可作为前列腺癌患者首选的手术方式。     

Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials

The aim of this study is to assess the overall efficacy and safety of photoselective vaporization of the prostate (PVP) with GreenLight 120-W laser versus transurethral resection of the prostate (TURP) for treating patients of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). We performed a literature search of The Cochrane Library and the electronic databases, including Embase, Medline, and Web of Science. Manual searches were conducted of the conference proceedings, including European Association of Urology and American Urological Association (2007 to 2012). Outcomes reviewed included clinical baseline characteristics, perioperative data, complications, and postoperative functional results, such as postvoid residual (PVR), international prostate symptom score (IPSS), quality of life (QoL), and maximum flow rate (Q_max). Six randomized controlled trials (RCTs) were enrolled. Three hundred and forty-seven patients undergone 120-W PVP, and 350 patients were treated with TURP in the RCTs. There were no significant differences for clinical characteristics in these trials. In perioperative data, catheterization time and length of hospital stay were shorter in the PVP group. However, the operation time was shorter in the TURP group. Capsular perforation, blood transfusion, clot retention, and macroscopic hematuria were markedly less likely in PVP-treated subjects. The other complications between PVP and TURP did not demonstrate a statistic difference. There were no significant differences in QoL, PVR, IPSS, and Q_max in the 1, 3, 6, 12, and 24 months of postoperative follow-up. There was no significant difference at postoperation follow-up of functional outcomes including IPSS, PVR, Q_max, and QoL between the TURP-treated subjects and PVP-treated subjects. Owing to a shorter catheterization time, reduced hospital duration and less complication, PVP could be used as an alternative and a promising minimal invasive surgical procedure for the treatment of BPH.     

良性前列腺增生患者经尿道前列腺切除术后排尿症状改变及分析

目的 研究良性前列腺增生患者经尿道前列腺切除术后排尿症状的变化及其与术前临床参数的关系。方法 对281例良性前列腺增生手术患者进行随访,对其手术前、后排尿症状评分和术前临床资料进行分析。患者年龄（70±6）岁。术前前列腺体积（75±39）ml,血清总前列腺特异性抗原（T—PSA）（5±5）ng／ml,最大尿流率（8±3）ml／s,切除前列腺重量（32±19）g。术前国际前列腺症状评分（IPSS）（24±7）分,生活质量评分（QOL）（4．6±1．0）分,平均梗阻症状（3．6±1．2）分,平均刺激症状（3．5±1．0）分。结果 术后IPSS（7±7）分,生活质量评分（1．2±1．1）分,与术前相比,均明显改善。不同排尿症状改善的幅度不同,平均梗阻症状的改善幅度大于平均刺激症状的改善。术后夜尿和尿频分别为（2．2±1．1）分和（1．2±1．4）分。结论 经尿道前列腺切除患者术后排尿症状明显改善,症状的改善程度与术前IPSS和QOL相关,而与患者年龄、术前前列腺体积、T-PSA、最大尿流率、切除前列腺重量无相关性。梗阻症状的改善优于刺激症状的改善,而夜尿是改善幅度最小的症状。     

A multicenter retrospective study of transurethral prostate split for benign prostate hyperplasia

BackgroundTransurethral split of the prostate (TUSP) is effective in treating benign prostatic hyperplasia (BPH). However, there is still a lack of research focusing on the optimal target population for TUSP. This study aimed to compare the efficacy of TUSP in patients with different prostate volumes or ages.MethodsThe study was a multicenter retrospective study. The outcomes of TUSP in BPH patients with different prostate volumes or different ages were compared. A total of 439 patients were included in the study. Patients were divided into two groups according to prostate volume, with a cut-off value of 50 mL. Similarly, the cut-off value for the age groups was 70 years. Baseline patient characteristics and perioperative outcomes were recorded. Follow-up was performed at 1, 6, and 12 months after surgery.ResultsThe mean age of the patients was 73.4 years, and the mean prostate volume was 51.2 mL. At 12-month follow-up after TUSP treatment, the patients’ International Prostate Symptom Scores (IPSS), quality of life (QoL) scores, and postvoid residual (PVR) volumes decreased significantly, while peak urinary flow rate (Qmax) increased significantly. Intraoperative hemoglobin (Hb) reduction was significantly lower in the small volume group than in the large volume group. The incidence of postoperative urinary urgency and transient incontinence was lower in the small volume group. IPSS score, PVR, and Qmax in the small volume group showed more remarkable changes at several time points compared to the preoperative period. Postoperative pain scores were higher in the small volume group than in the large volume group. There were no differences between the two groups in terms of long-term complications. The younger group showed greater variation in PVR and Qmax at some time points but less variation in QoL than the older group.ConclusionsTUSP is overall safe and effective in treating BPH. This study showed differences in the outcomes of TUSP in treating different prostate volumes or ages of BPH patients. The optimal surgical approach for BPH patients might be selected clinically based on a combination of prostate volume or patient age.     

2μm激光汽化切除术治疗高龄高危良性前列腺增生

目的探讨2μm激光汽化切除术治疗高龄高危良性前列腺增生（BPH）的安全性和有效性。方法应用70W 2μm连续波医用激光对65例高龄高危BPH患者行2μm激光前列腺汽化切除术。患者年龄80~92岁,平均（84.6±2.7）岁。观察平均手术时间、术中出血量、术后留置尿管时间、手术并发症,记录并计算手术前后国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）及残余尿量（PVR）等指标的差异。结果全部手术均成功,平均手术时间（40.8±7.5）min,术中出血量（60.0±12.0）mL,无输血病例。术后平均留置尿管时间（3.0±1.0）d。术后随访3月,IPSS及QOL评分由术前平均24.6±4.5及5.2±0.2分别下降至6.8±1.2及1.4±0.3,Qmax由术前（4.3±0.5）mL/s增加至术后（18.6±1.5）mL/s,PVR由术前（60±0.5）mL下降至术后（15.6±4.6）mL,手术前后比较均有显著性差异（P〈0.01）。术后无尿失禁及继发性出血。结论 2μm激光前列腺汽化切除术治疗高龄高危BPH安全有效。     

经尿道钬激光前列腺剜除术治疗前列腺增生

目的评价经尿道钬激光前列腺剜除和前列腺组织粉碎术治疗良性前列腺增生（BPH）的临床效果,探讨手术操作技巧及并发症的预防。方法应用100 W钬激光器和组织粉碎器对45例BPH患者实施经尿道钬激光前列腺剜除（HoLEP）和组织粉碎术。术前国际前列腺症状评分（IPSS）为15-32分,平均24.0分,最大尿流率（Qmax）为4-15 mL/s,平均8.4 mL/s,膀胱残余尿为60-246 mL,平均115 mL。结果41例行HoLEP手术成功。手术时间50-200 min,平均105 min,获得前列腺组织30-85 g,平均48.6 g,其中输血5例,膀胱黏膜或膀胱壁损伤5例,尿失禁1例,尿道狭窄3例。保留导尿时间3-7 d,平均4.3 d。术后35例获随访3个月,IPSS降至3-10分,平均5.2分（P〈0.01）,Qmax升至18-25 mL/s,平均22.4 mL/s（P〈0.01）,膀胱残余尿为0-68 mL,平均26 mL（P〈0.01）。结论经尿道钬激光剜除前列腺组织损伤小,术中出血少,并发症少,疗效可靠。HoLEP学习曲线较长,应注意手术技巧的掌握,减少并发症的发生。     

Feedback microwave thermotherapy with the ProstaLund Compact Device for obstructive benign prostatic hyperplasia: 12-month response rates and complications

PURPOSE: To evaluate the effectiveness of the ProstaLund Compact Device in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: A series of 38 consecutive patients with a mean age of 72.6+/-8.2 years, 19 with an indwelling catheter, underwent transurethral microwave thermotherapy (TUMT) with the ProstaLund Compact Device. Pretreatment evaluation included transrectal ultrasonography (TRUS), urodynamics, and cystoscopy for all patients and flow rate (Qmax), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS), and quality-of-life (QoL) assessment for those without a catheter. The mean prostate volume was 63.5+/-30 cc. The Qmax, IPSS, and QoL studies were repeated at 3, 6, and 12 months, while urodynamics, cystoscopy, and TRUS were repeated at 6 and 12 months. RESULTS: The treatment lasted a mean of 43.1+/-17.1 minutes, achieved a maximal intraprostatic temperature of 58.7+/-7.2 degrees C, and destroyed 18.4+/-14.3 g of prostatic tissue. Twelve months post-treatment, for the patients without a catheter preoperatively, the IPSS was improved from 21.5+/-6.3 to 6.5+/-3.1 (P<0.001), Qmax from 7.2+/-3.1 mL/sec to 18.1+/-7.4 mL/sec (P<0.001), detrusor pressure at Qmax from 87.5+/-15 cm H2O to 48.4+/-16.4 cm H2O (P<0.001), and PVR from 113.2+/-78.2 mL to 34.6+/-36.7 mL (P<0.01). The good-response rates for IPSS (or=50% improvement), Qmax (>or=15 mL/sec or >or=50% improvement), PVR (<50 mL or >or=50% decrease), and QoL (相似文献   

Long-term treatment outcome of tamsulosin for benign prostatic hyperplasia

BACKGROUND: The present study assessed the long-term efficacy (>12 months) of tamsulosin in 123 patients with lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). METHODS: The patients received a starting dose of tamsulosin of 0.2 mg/day, with a further titration up to 0.4 mg/day until symptom relief. Subjective and objective clinical variables were assessed using the international prostate symptom score (IPSS), IPSS quality of life (QoL) score, BPH impact index score, peak urinary flow rate (Q(max)) and postvoid residual urine volume. RESULTS: Except for Q(max), all clinical variables showed significant sustained improvements from baseline throughout the study period (median follow up, 43 months). Thirty patients (24.4%) withdrew because of surgical interventions. The Cox proportional hazards model showed that a baseline IPSS total score >or=15 (HR [hazard ratio] 2.13; 95% CI 1.04-4.34) was predictive of failure for tamsulosin therapy. Furthermore, during the first 12 months, a lowest IPSS total score >or=13 (HR 2.34; 95% CI 1.12-4.89), a lowest IPSS QoL score >or=3 (HR 4.16; 95% CI 1.26-13.68), and a lowest BPH impact index score >or=4 (HR 3.54; 95% CI 1.62-7.75) were also predictive of failure for tamsulosin therapy. CONCLUSIONS: Tamsulosin treatment of BPH patients for more than 12 months showed a sustained, stable efficacy. Patients without short-term effects were prone to withdraw from tamsulosin therapy, but so did patients with a high baseline IPSS total score, even if therapy was effective for at least 12 months.     

Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): a prospective bi-centre study of perioperative morbidity and early functional outcome

OBJECTIVES: To compare the early follow-up and perioperative morbidity of photoselective vaporization (PVP) and transurethral resection of the prostate (TURP) in patients (pts.) suffering from lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). MATERIAL AND METHOD: 101 pts. underwent PVP (n = 64) and TURP (n = 37) in a prospective, non-randomized bi-centre trial. Inclusion criteria were identical at both centres. Primary outcome parameters were maximum urinary flow rate (Q(max)), post-void residual volume (V(res)), International Prostate Symptom Score (IPSS). Secondary outcomes included intraoperative surgical parameters and perioperative and post-discharge morbidity. RESULTS: Baseline characteristics of both groups were similar. Operating time was slightly shorter in the TURP group (p = 0.047). During TURP significant more irrigation solution was used (p < 0.001). Decrease of serum haemoglobin (p = 0.027) and serum sodium (p = 0.013) was larger after TURP. Catheter drainage was removed significant earlier after PVP than after TURP (p < 0.001). Outcome of Q(max), and IPSS were similar in both groups within 6 months. The sort of perioperative complications was different in both groups, however overall cumulative perioperative morbidity was comparable (PVP 39.1% versus TURP 43.2.1%; ns). CONCLUSION: PVP provides excellent intraoperative safety, instant tissue removal, and immediate relief from obstructive voiding symptoms, similar to TURP. Early outcomes 6-months after PVP and TURP are comparable.     

Photoselective vaporization of the prostate: the basel experience after 108 procedures

OBJECTIVES: This study aims to investigate safety and efficacy of 80 watt high-power potassium titanyl phosphate (KTP) laser vaporization of the prostate in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS: 108 patients underwent 80W KTP laser vaporization. Functional follow-up included measurement of maximum urinary flow rate (Qmax), postvoid residual volume (Vres) and International Prostate Symptom Score (IPSS) within a 12 months period. RESULTS: The average prostate volume was 52.2+/-24.3 ml and the preoperative PSA value was 3.6+/-3.6 ng/dl. Mean operation time was 54.5+/-25.0 min. Qmax increased highly significantly (p<0.001) by 111% (+7.9 ml/s) at discharge, 212% (+15.1 ml/s) after three months, 201% (+14.3 ml/s) after six months and 252% (+17.9 ml/s) after 12 months. Correspondingly, Vres, IPSS and Bother Score improved to an extent that was statistically highly significant (p<0.001) immediately after surgery. The observed complication rate within one year was low. CONCLUSIONS: 80 W KTP laser vaporization is a virtually bloodless, safe and effective procedure for surgical treatment of LUTS secondary to BPH. A significant improvement of objective and subjective voiding parameters was observed just after surgery. KTP laser vaporization is associated with a low rate of complications.