Knoll T, Michel M S, Trojan L, Bross S, Alken P, Köhrmann K U
Urologische Klinik. Klinikum Mannheim gGmbH, Universitätsklinikum, Mannheim.
Aktuelle Urol. 2003 Jan;34(1):48-51. doi: 10.1055/s-2003-37559.
Besides standard open or transurethreal adenoma resection, less morbid interstitial laser coagulation (ILC) is an alternative therapeutical option that could reduce lower urinary tract symptoms, especially in high-risk patients. Although short-term results indicate effectiveness, reliable long-term statistics are still lacking. Therefore, to assess long-term satisfaction and overall success rate, we re-evaluated patients with a mean follow-up of 7 years after laser treatment.
A total of 72 patients had been included in our ILC programme between 1993 and 1995. Mean age was 74 years. About 45 % of the patients had since died of other causes. In all, 23 patients were evaluated by telephone questionnaire, International Prostate Symptom Score (IPSS), Quality of Life (QoL), second surgical interventions or medical therapy. Our patient group was treated with interstitial Nd:YAG laser coagulation (mediLas fibertom). A perineal (34 %), transurethral (23 %) or combined (43 %) approach was chosen, depending on the preoperative volume of the prostate (range 40 - 100 ml; mean 59.3 ml).
68.4 % of the patients were satisfied with their current urological situation. Mean IPSS was 8.8 vs. 18.8 preoperatively mean QoL 1.5 vs. 3.3. 15.8 % had undergone conventional transurethral prostatic resection in the interim; one patient uses a urine catheter. 15.8 % receive medical treatment for lower urinary tract symptoms.
Although the results of standard TUR or open surgery imply higher success, the long-term results of ILC demonstrate effectiveness. Further follow-up studies on a larger number of patients are advisable. The low morbidity of ILC makes this procedure an interesting alternative option in the treatment of high risk patients.
除了标准的开放性或经尿道腺瘤切除术外，创伤较小的间质激光凝固术（ILC）是一种可减少下尿路症状的替代治疗选择，尤其适用于高危患者。尽管短期结果显示其有效，但仍缺乏可靠的长期统计数据。因此，为了评估长期满意度和总体成功率，我们对激光治疗后平均随访7年的患者进行了重新评估。
1993年至1995年间，共有72例患者纳入我们的ILC治疗方案。平均年龄为74岁。约45%的患者此后死于其他原因。总共23例患者通过电话问卷、国际前列腺症状评分（IPSS）、生活质量（QoL）、二次手术干预或药物治疗进行评估。我们的患者组接受了间质钕：钇铝石榴石激光凝固术（mediLas fibertom）治疗。根据术前前列腺体积（范围40 - 100 ml；平均59.3 ml），选择经会阴（34%）、经尿道（23%）或联合（43%）入路。
68.4%的患者对其当前的泌尿系统状况感到满意。平均IPSS为8.8，术前为18.8；平均QoL为1.5，术前为3.3。在此期间，15.8%的患者接受了传统经尿道前列腺切除术；1例患者使用尿管。15.8%的患者因下尿路症状接受药物治疗。
尽管标准经尿道前列腺切除术（TUR）或开放手术的结果显示成功率更高，但ILC的长期结果证明了其有效性。建议对更多患者进行进一步的随访研究。ILC的低发病率使其成为治疗高危患者的一个有吸引力的替代选择。
