Tuhkanen K, Heino A, Alaopas M
Department of Urology, University Hospital, Kuopio, Finland.
BJU Int. 1999 Nov;84(7):805-9. doi: 10.1046/j.1464-410x.1999.00316.x.
To compare the efficacy and safety of hybrid laser treatment, i.e. the combination of visual Nd-YAG laser ablation of prostate and contact Nd-YAG laser vaporization of prostate, with transurethral resection of the prostate (TURP) in the treatment of patients with symptomatic bladder outlet obstruction secondary to a benign high-volume prostate.
Forty-five symptomatic patients with hyperplastic prostates of >40 mL were randomized to undergo either hybrid laser treatment (21) or TURP (24). All patients were evaluated before and after treatment with a complex urodynamic assessment, and were accepted into the study only if they had infravesical obstruction in the pressure-flow study. In the hybrid method, Nd-YAG laser energy was first delivered by an 'adenoma-dependent' approach to all areas of the obstructing lateral lobe tissue through a side-firing gold-alloy tip fibre at 40 W for 90 s of 'burn'. The prostatic urethra was then opened and the median lobe vaporized using the a contact probe at 40 W. Patients were re-evaluated 3 and 6 months after treatment.
Both treatments proved to be safe, and improved the subjective and objective outcome measures at 3 and 6 months compared with baseline values. After 3 months, there was a greater improvement in the TURP group in peak urinary flow rate (Qmax; P<0.01), mean urinary flow rate (Qave; P<0.01) and postvoid residual urine volume (P<0.05) than in the hybrid laser group. After 6 months, there was a greater improvement in the TURP group in detrusor pressure at Qmax (P<0.01), Qave (P<0.05) and prostate size (P<0.001) than in the hybrid laser group. In the pressure-flow study at 6 months, a higher proportion of patients (seven of 19) were still obstructed in the hybrid laser group than in TURP group (two of 21; P<0.05). TURP caused more intraoperative blood loss (P<0.001) and postoperative problems associated with bleeding; 38% of hybrid laser patients were discharged with a suprapubic catheter, whereas all TURP patients could urinate at discharge (P<0.01). The duration of bladder drainage was longer after hybrid laser treatment (P<0.001).
The hybrid laser method was a safe but less effective treatment than TURP for benign prostatic enlargement in patients with prostates of >40 mL.
比较混合激光治疗（即视觉钕 - 钇铝石榴石激光前列腺切除术与接触式钕 - 钇铝石榴石激光前列腺汽化术联合应用）与经尿道前列腺切除术（TURP）治疗良性大体积前列腺导致的有症状膀胱出口梗阻患者的疗效和安全性。
45例前列腺增生体积>40 mL且有症状的患者被随机分为接受混合激光治疗组（21例）或TURP组（24例）。所有患者在治疗前后均接受综合尿动力学评估，且仅当他们在压力 - 流率研究中有膀胱下梗阻时才被纳入研究。在混合治疗方法中，首先通过侧射金合金尖端光纤以40 W的功率对梗阻侧叶组织的所有区域采用“腺瘤依赖”方法输送钕 - 钇铝石榴石激光能量，进行90秒的“烧灼”。然后打开前列腺尿道，使用接触探头以40 W的功率汽化中叶。治疗后3个月和6个月对患者进行重新评估。
两种治疗方法均被证明是安全的，并且与基线值相比，在3个月和6个月时主观和客观结果指标均有所改善。3个月后，TURP组在最大尿流率（Qmax；P<0.01）、平均尿流率（Qave；P<0.01）和排尿后残余尿量（P<0.05）方面的改善比混合激光组更大。6个月后，TURP组在Qmax时的逼尿肌压力（P<0.01）、Qave（P<0.05）和前列腺大小（P<0.001）方面的改善比混合激光组更大。在6个月时的压力 - 流率研究中，混合激光组仍有梗阻的患者比例（19例中的7例）高于TURP组（21例中的2例；P<0.05）。TURP导致更多术中失血（P<0.001）和与出血相关的术后问题；38%的混合激光治疗患者出院时带有耻骨上导尿管，而所有TURP患者出院时都能排尿（P<0.01）。混合激光治疗后膀胱引流持续时间更长（P<0.001）。
对于前列腺体积>40 mL的良性前列腺增生患者，混合激光方法是一种安全但比TURP效果差的治疗方法。
