Poulakis Vassilis, Dahm Philipp, Witzsch Ulrich, Sutton Alex J, Becht Eduard
Department of Urology and Paediatric Urology, Krankenhaus Nordwest, Teaching Hospital of the Johann-Wolfgang-Goethe-University Frankfurt, Frankfurt/Main, Germany.
BJU Int. 2004 Jul;94(1):89-95. doi: 10.1111/j.1464-410X.2004.04907.x.
To compare the effectiveness and safety of transurethral electrovaporization (TUEVP) and transurethral resection of the prostate (TURP) for symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH).
Publications comparing TUEVP and TURP were identified systematically using Medline, the Cochrane Controlled Trial Register and other database search engines. From a total of 25 randomized controlled trials, 20 studies met the predefined inclusion criteria and were subjected to a formal meta-analysis. Primary endpoints were symptom scores and peak urinary flow rates. Secondary endpoints included transfusion requirements, operative time, duration of catheterization, incidence of adverse events, hospital stay, re-operation rates and sexual dysfunction.
After 1 year of follow-up there was no significant difference between TUEVP and TURP in urinary symptom scores and peak urinary flow rates. There was heterogeneity at baseline for both primary outcome measures. TUEVP was associated with significantly lower transfusion requirements, a shorter catheterization time, and a shorter length of stay. TURP was associated with a lower risk of urinary retention afterward and re-operation than was TUEVP.
This formal meta-analysis suggests that both TUEVP and TURP in patients with symptomatic bladder outlet obstruction provide comparable improvements in maximum urinary flow rates and symptom scores. While comparative analysis is limited by the methodological shortcomings of the underlying studies and the short follow-up, both TURP and TUEVP may offer distinct advantages in terms of secondary outcomes. A future, well-designed, multicentre randomized clinical trial with extended follow-up may be needed to better define the role of vaporization techniques in treating patients with symptomatic BPH.
比较经尿道电汽化术（TUEVP）与经尿道前列腺切除术（TURP）治疗良性前列腺增生（BPH）所致有症状膀胱出口梗阻的有效性和安全性。
通过检索Medline、Cochrane对照试验注册库及其他数据库搜索引擎，系统识别比较TUEVP和TURP的文献。在总共25项随机对照试验中，20项研究符合预先设定的纳入标准，并进行了正式的荟萃分析。主要终点为症状评分和最大尿流率。次要终点包括输血需求、手术时间、导尿持续时间、不良事件发生率、住院时间、再次手术率和性功能障碍。
随访1年后，TUEVP和TURP在尿路症状评分和最大尿流率方面无显著差异。两种主要结局指标在基线时均存在异质性。TUEVP的输血需求显著更低，导尿时间更短，住院时间更短。与TUEVP相比，TURP术后尿潴留和再次手术的风险更低。
这项正式的荟萃分析表明，对于有症状膀胱出口梗阻的患者，TUEVP和TURP在最大尿流率和症状评分方面的改善相当。虽然比较分析受到基础研究方法学缺陷和随访时间短的限制，但TURP和TUEVP在次要结局方面可能都有明显优势。未来可能需要设计良好、多中心、随访时间更长的随机临床试验，以更好地明确汽化技术在治疗有症状BPH患者中的作用。
