Kaye Jonathan D, Smith Arthur D, Badlani Gopal H, Lee Benjamin R, Ost Michael C
Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA.
J Endourol. 2008 Apr;22(4):713-8. doi: 10.1089/end.2007.0039.
Minimally invasive office-based treatments for benign prostatic hyperplasia (BPH) are challenging the traditional surgical and medical management options for symptomatic BPH. We conducted a meta-analysis of published randomized controlled trials that compared high-energy transurethral microwave thermotherapy (HE-TUMT) with transurethral resection of the prostate (TURP) to compare subjective and objective outcomes.
A literature search using Pub-Med was conducted to obtain all published data on HE-TUMT and all randomized controlled trials that compared HE-TUMT with TURP. Data were analyzed focusing on the pretreatment and posttreatment end points of the International Prostate Symptom Score(IPSS), maximum flow rate (Q(max)), and postvoid residual (PVR). A meta-analysis was conducted, and data were stratified with respect to the type of HE-TUMT machinery used.
A total of 458 patients were studied. Differences in IPSS, Q(max), and PVR from current trials that compared TURP with HE-TUMT are best evaluated at 1-year follow-up. At this time point, changes in Q(max) (P < 0.001), IPSS (P = 0.01), and PVR (P = 0.02) are more significant if TURP is the management mode. HE-TUMT with the CoreTherm() device demonstrates the most significant improvements in subjective and objective criteria that approximate outcomes with TURP (Figs. 1-3).
A meta-analysis of current randomized controlled trials that compared TURP with HE-TUMT demonstrates more significant changes in Q(max), IPSS, and PVR when TURP is used to manage symptomatic BPH. Despite these statistical differences, stratified data demonstrate that current HE-TUMT machinery is more effective than previously used lower-energy machinery, especially at objective end points. This is most evident when the CoreTherm device is used. These findings, coupled with the decreased costs and morbidity associated with HE-TUMT, support this treatment as a reasonable alternative to TURP.
基于门诊的良性前列腺增生（BPH）微创治疗正在挑战有症状BPH的传统手术和药物治疗选择。我们对已发表的随机对照试验进行了荟萃分析，比较了高能经尿道微波热疗（HE-TUMT）与经尿道前列腺切除术（TURP），以比较主观和客观结果。
利用PubMed进行文献检索，以获取关于HE-TUMT的所有已发表数据以及所有比较HE-TUMT与TURP的随机对照试验。分析的数据聚焦于国际前列腺症状评分（IPSS）、最大尿流率（Q(max)）和残余尿量（PVR）的治疗前和治疗后终点。进行了荟萃分析，并根据所使用的HE-TUMT器械类型对数据进行分层。
共研究了458例患者。比较TURP与HE-TUMT的当前试验中，IPSS、Q(max)和PVR的差异在1年随访时评估最佳。在这个时间点，如果采用TURP治疗方式，Q(max)（P < 0.001）、IPSS（P = 0.01）和PVR（P = 0.02）的变化更显著。使用CoreTherm()设备的HE-TUMT在主观和客观标准方面显示出最显著的改善，接近TURP的结果（图1 - 3）。
对比较TURP与HE-TUMT的当前随机对照试验进行的荟萃分析表明，当使用TURP治疗有症状的BPH时，Q(max)、IPSS和PVR有更显著的变化。尽管存在这些统计学差异，但分层数据表明，当前的HE-TUMT器械比以前使用的低能量器械更有效，尤其是在客观终点方面。使用CoreTherm设备时最为明显。这些发现，再加上与HE-TUMT相关的成本降低和发病率降低，支持将这种治疗作为TURP的合理替代方案。
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