Ruszat Robin, Seitz Michael, Wyler Stephen F, Müller Georg, Rieken Malte, Bonkat Gernot, Gasser Thomas C, Reich Oliver, Bachmann Alexander
Department of Urology, Basel University Hospital, Basel, Switzerland.
BJU Int. 2009 Sep;104(6):820-5. doi: 10.1111/j.1464-410X.2009.08452.x. Epub 2009 Feb 23.
To evaluate the safety, efficacy and short-term outcome of a new 980 nm high-intensity diode (HiDi) laser (Limmer Laser, Berlin, Germany) system in comparison to the diode-pumped solid-state laser high-performance system (HPS; GreenLight(TM), AMS, Minnetonka, MI, USA) for treating benign prostatic hyperplasia (BPH) in a prospective non-randomized single-centre study.
From February to September 2007, 117 consecutive patients with lower urinary tract symptoms secondary to BPH were included; 62 patients were treated with 120-W HPS laser vaporization and 55 with 980-nm HiDi laser ablation of the prostate. We evaluated perioperative variables, and complications during and after surgery. Patients presenting for follow-up completed the International Prostate Symptom Score, and had their maximum urinary flow rate and postvoid residual urine volume measured.
The mean (sd) age of the patients was 72.3 (8.8) years (HiDi) and 73.1 (10.8) years (HPS), with a mean preoperative prostate volume of 64.7 (29.7) and 67.4 (46.9) mL, respectively. The mean operative duration was comparable, at 56.4 (20.2) and 62.7 (36.3) min, respectively, whereas the mean energy delivery was significantly higher with the diode laser, at 313 (132) vs 187 (129) kJ (P < 0.001). For patients treated with the HPS the rate of visual impairment from bleeding was higher (0% vs 12.9%, P < 0.01), as was prostate capsule perforation (0% vs 4.8%, P > 0.05). Soon after surgery the rate of dysuria (23.6% vs 17.7%, P > 0.05) and transient urge incontinence (7.3% vs 0%; P < 0.05) was higher for the HiDi laser. During the follow-up there were higher rates of bladder neck stricture (14.5% vs 1.6%, P < 0.01), re-treatment (18.2% vs 1.6%, P < 0.01) and stress urinary incontinence (9.1% vs 0%; P < 0.05) for the HiDi laser group.
Both systems investigated provide good tissue ablative properties. The HiDi laser at 980 nm is more favourable in terms of haemostasis. The penetration depths, resulting in coagulation necrosis and leading to increased re-treatment, bladder neck stricture and incontinence rates, were higher with the HiDi laser.
在一项前瞻性非随机单中心研究中，评估一种新型980纳米高功率二极管（HiDi）激光系统（德国柏林的Limmer Laser）与二极管泵浦固态激光高性能系统（HPS；美国明尼通卡的AMS公司的GreenLight™）治疗良性前列腺增生（BPH）的安全性、有效性和短期结果。
2007年2月至9月，纳入117例因BPH继发下尿路症状的连续患者；62例患者接受120瓦HPS激光汽化治疗，55例接受980纳米HiDi激光前列腺消融治疗。我们评估了围手术期变量以及手术期间和术后的并发症。前来随访的患者完成国际前列腺症状评分，并测量其最大尿流率和排尿后残余尿量。
患者的平均（标准差）年龄为72.3（8.8）岁（HiDi组）和73.1（10.8）岁（HPS组），术前平均前列腺体积分别为64.7（29.7）和67.4（46.9）毫升。平均手术时间相当，分别为56.4（20.2）和62.7（36.3）分钟，而二极管激光的平均能量输送显著更高，为313（132）千焦对187（129）千焦（P < 0.001）。接受HPS治疗的患者因出血导致视力损害的发生率更高（0%对12.9%，P < 0.01），前列腺包膜穿孔发生率也更高（0%对4.8%，P > 0.05）。术后不久，HiDi激光组的排尿困难发生率（23.6%对17.7%，P > 0.05）和短暂性急迫性尿失禁发生率（7.3%对0%；P < 0.05）更高。在随访期间，HiDi激光组膀胱颈狭窄发生率（14.5%对1.6%，P < 0.01）、再次治疗发生率（18.2%对1.6%，P < 0.01）和压力性尿失禁发生率（9.1%对0%；P < 0.05）更高。
所研究的两种系统均具有良好的组织消融特性。980纳米的HiDi激光在止血方面更具优势。HiDi激光的穿透深度更大，导致凝固性坏死，进而使再次治疗、膀胱颈狭窄和尿失禁发生率增加。
