Department of Urology, Royal Melbourne Hospital, Melbourne University, Australia.
BJU Int. 2010 Apr;105(7):964-9. doi: 10.1111/j.1464-410X.2009.08961.x. Epub 2009 Nov 12.
To compare the potassium-titanyl-phosphate Greenlight(TM) 80-W laser ablation system for photovaporization of the prostate (PVP; Laserscope, San Jose, CA, USA) with transurethral resection of the prostate (TURP), as many technologies have been proposed as equivalent or superior to TURP without gaining widespread acceptance, due to lack of data from randomized trials.
In all, 120 patients were randomized to undergo either TURP or PVP after a full urological evaluation, which was repeated at 1, 3, 6 and 12 months after surgery. Irrigation use, duration of catheterization (DOC), length of hospital stay (LOS), blood loss, cost and operative time were also assessed.
Both groups showed a significant increase in mean (sd) maximum urinary flow rate from baseline (P < 0.05); in the TURP group from 8.9 (3.0) to 19.4 (8.7) mL/s (154%), and in the PVP group from 8.8 (2.5) to 18.6 (8.2) mL/s (136%). The International Prostate Symptom Score (IPSS) decreased from 25.4 (5.7) to 10.9 (9.4) in the TURP group (53%), and from 25.3 (5.9) to 8.9 (7.6) in the PVP group (61%). The trends were similar for the bother and Quality of Life scores. There was no difference in sexual function as measured by Baseline Sexual Function Questionnaires. The DOC was significantly less in the PVP than the TURP group (P < 0.001), with a mean (range) of 13 (0-24) h vs 44.7 (6-192) h. The situation was similar for LOS (P < 0.001), with a mean (range) of 1.09 (1-2) and 3.6 (3-9) days in the PVP and TURP groups, respectively. Adverse events and complications were less frequent in the PVP group. Costs were also 22% less in the PVP group.
This trial shows that PVP is an effective technique when compared to TURP, producing equivalent improvements in flow rates and IPSS with the advantages of markedly reduced LOS, DOC and adverse events. A long-term follow-up is being undertaken to ensure durability of these results.
比较经尿道前列腺绿激光（Laserscope，圣何塞，CA，美国）前列腺 80-W 激光消融术（PVP）与经尿道前列腺切除术（TURP），因为许多技术已被提出与 TURP 相当或优于 TURP，但由于缺乏随机试验数据，尚未得到广泛接受。
所有患者均接受完整的泌尿科评估，然后随机分为 TURP 或 PVP 组，术后 1、3、6 和 12 个月重复评估。还评估了冲洗使用、留置导尿时间（DOC）、住院时间（LOS）、出血量、成本和手术时间。
两组患者最大尿流率均从基线显著增加（P<0.05）；TURP 组从 8.9（3.0）增加到 19.4（8.7）mL/s（154%），PVP 组从 8.8（2.5）增加到 18.6（8.2）mL/s（136%）。国际前列腺症状评分（IPSS）从 TURP 组的 25.4（5.7）降至 10.9（9.4）（53%），从 25.3（5.9）降至 8.9（7.6）（61%）在 PVP 组。困扰和生活质量评分也呈现类似趋势。Baseline Sexual Function Questionnaires 测量的性功能无差异。PVP 组的 DOC 明显低于 TURP 组（P<0.001），平均（范围）为 13（0-24）h 对 44.7（6-192）h。LOS 情况也类似（P<0.001），PVP 组平均（范围）为 1.09（1-2）天，TURP 组为 3.6（3-9）天。PVP 组不良事件和并发症发生率较低。PVP 组的成本也降低了 22%。
本试验表明，与 TURP 相比，PVP 是一种有效的技术，在流量和 IPSS 方面产生等效改善，具有 LOS、DOC 和不良事件明显减少的优势。正在进行长期随访以确保这些结果的耐久性。
