Schatzl G, Madersbacher S, Djavan B, Lang T, Marberger M
Department of Urology, University of Vienna, Austria.
Eur Urol. 2000 Jun;37(6):695-701. doi: 10.1159/000020220.
The aim of this study was to compare the efficacy or transurethral resection of the prostate (TURP) versus four less invasive treatment options during a 2-year follow-up.
95 elderly men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) were assigned prospectively to the following five treatment arms; transurethral resection of the prostate (TURP; n = 28), transurethral electrovaporization (TUVP; n = 17), visual laser ablation of the prostate (VLAP; n = 17), transrectal high intensity focused ultrasound (HIFU; n = 20) and transurethral needle ablation (TUNA); n = 15). Preoperative workup included the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual volume (PVR), prostate volume determined by transrectal ultrasonography and a multichannel pressure flow study. Postoperative follow-up at 6, 12, 18 and 24 months included assessment of IPSS, PVR and uroflowmetry.
At study entry, patients assigned to one of the five treatment arms were comparable with respect to age, peak flow rate (Q(max)), IPSS, prostate size and the degree of bladder outflow obstruction. During study, 1 patient in the TURP group (4%) required a secondary TURP, as compared to 23.5% (n = 4) after TUVP, 26.7% (n = 4) after VLAP, 15% (n = 4) after HIFU and 20% (n = 3) following TUNA. In patients not subjected to a secondary procedure, the IPSS decreased a mean 13. 9 after TURP, as compared to 12.7 after TUVP, 12.9 after VLAP, 7.0 after HIFU, and 9.8 after TUNA. Q(max) increased 11.5 ml/s (mean) after TURP, as compared to 11.1 ml/s after TUVP, 5.6 ml/s after VLAP, 2.5 ml/s after HIFU and 2.3 ml/s after TUNA.
In up to a quarter of the patients, a secondary TURP is performed within the first 2 years after 'less invasive' procedures. These data underline the need for long-term studies to reliably assess the role of less invasive procedures and to indicate that TURP is still competitive.
本研究旨在比较经尿道前列腺切除术（TURP）与四种侵入性较小的治疗方法在2年随访期内的疗效。
95例因良性前列腺增生（BPH）导致下尿路症状的老年男性被前瞻性地分配到以下五个治疗组；经尿道前列腺切除术（TURP；n = 28）、经尿道电气化术（TUVP；n = 17）、直视激光前列腺切除术（VLAP；n = 17）、经直肠高强度聚焦超声（HIFU；n = 20）和经尿道针刺消融术（TUNA；n = 15）。术前检查包括国际前列腺症状评分（IPSS）、尿流率测定、排尿后残余尿量（PVR）、经直肠超声测定前列腺体积以及多通道压力流研究。术后6、12、18和24个月的随访包括对IPSS、PVR和尿流率的评估。
在研究开始时，分配到五个治疗组之一的患者在年龄、最大尿流率（Q（max））、IPSS、前列腺大小和膀胱出口梗阻程度方面具有可比性。在研究期间，TURP组有1例患者（4%）需要二次TURP，而TUVP后为23.5%（n = 4），VLAP后为26.7%（n = 4），HIFU后为15%（n = 4），TUNA后为20%（n = 3）。在未接受二次手术的患者中，TURP后IPSS平均下降13.9，而TUVP后为12.7，VLAP后为12.9，HIFU后为7.0，TUNA后为9.8。TURP后Q（max）平均增加11.5 ml/s，而TUVP后为11.1 ml/s，VLAP后为5.6 ml/s，HIFU后为2.5 ml/s，TUNA后为2.3 ml/s。
在高达四分之一的患者中，在“侵入性较小”的手术后的头2年内需要进行二次TURP。这些数据强调了进行长期研究以可靠评估侵入性较小的手术方法作用的必要性，并表明TURP仍然具有竞争力。
