高功率磷酸钛氧钾激光对大体积前列腺男性良性前列腺增生的光选择性汽化治疗

High-power potassium-titanyl-phosphate photoselective laser vaporization of prostate for treatment of benign prostatic hyperplasia in men with large prostates.

作者信息

Sandhu Jaspreet S, Ng Casey, Vanderbrink Brian A, Egan Celeste, Kaplan Steven A, Te Alexis E

机构信息

Department of Urology, New York Presbyterian Hospital Cornell University Weill Medical College, New York, New York 10021, USA.

出版信息

Urology. 2004 Dec;64(6):1155-9. doi: 10.1016/j.urology.2004.07.018.

DOI:10.1016/j.urology.2004.07.018

PMID:15596189

Abstract

OBJECTIVES

To study the safety and efficacy of high-power potassium-titanyl-phosphate photoselective laser vaporization of the prostate in men with prostate volumes greater than 60 cm3.

METHODS

A total of 64 men with symptomatic benign prostatic hyperplasia and large-volume prostates underwent photoselective laser vaporization of the prostate between May 2002 and September 2003. Medical therapy had failed in all men, and 18 presented with urinary retention. The preoperative evaluation included the maximal flow rate, postvoid residual urine volume, prostate volume, serum sodium, creatinine, and hematocrit, and International Prostate Symptom Score. Transurethral prostatectomy was performed with an 80 W potassium-titanyl-phosphate (KTP) side-firing laser system through a 23F continuous-flow cystoscope with normal saline as the irrigant. The operative time, anesthesia type, length of stay, and postoperative serum sodium, creatinine, and hematocrit were recorded. The International Prostate Symptom Score, maximal flow rate, and postvoid residual urine volume were measured at each follow-up visit.

RESULTS

The mean preoperative prostate volume was 101 +/- 40 cm3. The mean operative time was 123 +/- 70 minutes. No transfusions were required. Of the 64 patients, 62 were discharged within 23 hours. The serum sodium level did not change significantly. The International Prostate Symptom Score decreased from 18.4 preoperatively to 9.9, 8.6, 7.2, and 6.7 at 1, 3, 6, and 12 months postoperatively, and the maximal flow rate increased from 7.9 mL/s preoperatively to 16.4, 16.2, 20.0, and 18.9 mL/s at 1, 3, 6, and 12 months postoperatively. The postvoid residual urine volume also decreased from 189 mL preoperatively to 78, 78, 67, and 109 mL at 1, 3, 6, and 12 months postoperatively.

CONCLUSIONS

Photoselective laser vaporization of the prostate is safe and efficacious, with durable results for men with symptomatic benign prostatic hyperplasia and large-volume prostates.

摘要

目的

研究高功率磷酸钛氧钾光选择性汽化术治疗前列腺体积大于60立方厘米男性患者的安全性和有效性。

方法

2002年5月至2003年9月，共有64例有症状的良性前列腺增生和大体积前列腺患者接受了前列腺光选择性汽化术。所有患者药物治疗均失败，其中18例出现尿潴留。术前评估包括最大尿流率、排尿后残余尿量、前列腺体积、血清钠、肌酐、血细胞比容以及国际前列腺症状评分。使用80W磷酸钛氧钾（KTP）侧射激光系统通过23F连续冲洗膀胱镜进行经尿道前列腺切除术，以生理盐水作为冲洗液。记录手术时间、麻醉类型、住院时间以及术后血清钠、肌酐和血细胞比容。每次随访时测量国际前列腺症状评分、最大尿流率和排尿后残余尿量。

结果

术前前列腺平均体积为101±40立方厘米。平均手术时间为123±70分钟。无需输血。64例患者中，62例在23小时内出院。血清钠水平无明显变化。国际前列腺症状评分从术前的18.4降至术后1、3、6和12个月时的9.9、8.6、7.2和6.7，最大尿流率从术前的7.9毫升/秒增至术后1、3、6和12个月时的16.4、16.2、20.0和18.9毫升/秒。排尿后残余尿量也从术前的189毫升降至术后1、3、6和12个月时的78、78、67和109毫升。