Kuntz Rainer M
Department of Urology, Auguste-Viktoria-Hospital, Berlin, Germany.
Eur Urol. 2006 Jun;49(6):961-9. doi: 10.1016/j.eururo.2006.03.028. Epub 2006 Mar 31.
Evaluate the current role of lasers in the treatment of benign prostatic hyperplasia (BPH).
The results of a MEDLINE search for randomised trials and case series of the last 5 yr and published review articles were analysed for the safety and efficacy of neodymium:yttrium aluminum garnet (Nd:YAG), potassium-titanyl-phosphate (KTP), and holmium (Ho):YAG laser prostatectomy. The analysis includes 12 reports on randomised clinical trials, 2 comparative studies, 10 review articles, and a total of >5000 patients.
Laser treatment of BPH has evolved from coagulation to enucleation. Blood loss is significantly reduced compared with transurethral resection and open prostatectomy. Visual laser ablation of the prostate and interstitial laser coagulation cause coagulative necrosis with secondary ablation. Long postoperative catheterisation, unpredictable outcomes, and high reoperation rates have restricted the use of these techniques. Ablative/vaporising techniques have become popular again with the marketing of new high-powered 80-W KTP and 100-W Ho lasers. Vaporisation immediately removes obstructing tissue. Short-term results are promising, but large series, long-term results, and randomised trials are lacking. Holmium laser enucleation (HoLEP) allows whole lobes of the prostate to be removed, mimicking the action of the index finger in open prostatectomy. Prostates of all sizes can be operated on. It is at least as safe and effective as transurethral resection of the prostate and open prostatectomy, with significantly lower morbidity. It is the only laser procedure that provides a specimen for histologic evaluation.
HoLEP appears to be a size-independent new "gold standard" in the surgical treatment of BPH.
评估激光在良性前列腺增生（BPH）治疗中的当前作用。
分析了MEDLINE搜索的过去5年的随机试验和病例系列以及已发表的综述文章，以探讨钕：钇铝石榴石（Nd:YAG）、磷酸钛钾（KTP）和钬（Ho）：YAG激光前列腺切除术的安全性和有效性。分析包括12篇关于随机临床试验的报告、2项比较研究、10篇综述文章，涉及患者总数超过5000例。
BPH的激光治疗已从凝固发展到剜除。与经尿道前列腺切除术和开放性前列腺切除术相比，出血量显著减少。前列腺可视激光消融和间质激光凝固会导致凝固性坏死并继发消融。术后长时间留置导尿管、结果不可预测以及再次手术率高限制了这些技术的应用。随着新型高功率80W KTP和100W Ho激光的上市，消融/汽化技术再次受到欢迎。汽化可立即去除阻塞组织。短期结果令人鼓舞，但缺乏大规模系列研究、长期结果和随机试验。钬激光剜除术（HoLEP）可切除整个前列腺叶，类似于开放性前列腺切除术中食指的操作。各种大小的前列腺都可进行手术。它至少与经尿道前列腺切除术和开放性前列腺切除术一样安全有效，发病率显著更低。它是唯一能提供组织学评估标本的激光手术。
HoLEP似乎是BPH手术治疗中一种与前列腺大小无关的新“金标准”。
