Departments of Urology, University Medical Center, Utrecht, the Netherlands.
BJU Int. 2010 Sep;106(6):822-6. doi: 10.1111/j.1464-410X.2010.09229.x. Epub 2010 Feb 22.
To compare long-term results of transurethral resection of the prostate (TURP), contact laser prostatectomy (CLP) and electrovaporization of the prostate (EVAP) in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).
Between 1996 and 2001, a prospective, randomized controlled trial was conducted in 150 men with LUTS suggestive of BPH, who had a prostate volume of 20-65 mL and a Schäfer's obstruction grade of > or =2. Outcome variables were the International Prostate Symptom Score (IPSS), Quality of Life (QoL) question, Symptom Problem Index (SPI), BPH Impact Index (BII), maximum urinary flow rate (Q(max)), prostate volume, prostate specific antigen (PSA) level, morbidity and mortality. In 2008 we carried out a long-term follow-up in these patients. Long-term values were compared with preoperative values for each treatment group (Wilcoxon signed-rank test), differences among groups were analysed (Kruskal-Wallis test) and actuarial failure-rates of the interventions were determined (Kaplan-Meier analysis).
Although we could account for 91% of the initial participants in 2008, 66 (44%) patients (29 TURP, 20 CLP and 17 EVAP) were available for follow-up measurements after a mean (range) of 10.1(6.9-12.7) years Among the three treatment groups, there were no significant differences in IPSS, QoL, SPI, BII, Q(max), PSA level and prostate volume. The IPSS, QoL, SPI and BII were still improved (P < 0.05) from values before treatment for all treatments. Only in the TURP group were the long-term results of Q(max) still improved (P < 0.05). The mortality rate was comparable among the treatments. The 10-year actuarial failure rates (95% confidence interval) were 0.11 (0.03-0.20), 0.22 (0.10-0.35) and 0.23 (0.11-0.35) for TURP, CLP and EVAP, respectively.
After a mean follow-up of 10.1 years, there were similar and durable improvements in IPSS, QoL, SPI and BII for patients with LUTS suggestive of BPH after TURP, CLP and EVAP. Between the treatment groups there were no statistically significant differences in Q(max), PSA levels and prostate volume at any time during the follow-up. However, only patients treated with TURP showed minimal durable improvements in Q(max). There was no statistically significant difference in success rate and mortality rate among the three treatments.
比较经尿道前列腺切除术（TURP）、接触式激光前列腺切除术（CLP）和前列腺电汽化术（EVAP）治疗有下尿路症状（LUTS）的良性前列腺增生（BPH）患者的长期疗效。
1996 年至 2001 年，对 150 名有 LUTS 症状且前列腺体积为 20-65ml、Schäfer 梗阻程度>或=2 的 BPH 患者进行前瞻性、随机对照试验。观察指标为国际前列腺症状评分（IPSS）、生活质量（QoL）评分、症状困扰指数（SPI）、良性前列腺增生影响指数（BII）、最大尿流率（Q(max)）、前列腺体积、前列腺特异性抗原（PSA）水平、发病率和死亡率。2008 年，我们对这些患者进行了长期随访。对每组的长期值与术前值进行比较（Wilcoxon 符号秩检验），分析组间差异（Kruskal-Wallis 检验），并通过 Kaplan-Meier 分析确定干预措施的累积失败率。
尽管我们在 2008 年可以追踪到 91%的初始参与者，但在平均（范围）10.1 年后（6.9-12.7 年），只有 66 名（44%）患者（29 名 TURP、20 名 CLP 和 17 名 EVAP）可进行随访测量。在三组治疗中，IPSS、QoL、SPI、BII、Q(max)、PSA 水平和前列腺体积均无显著差异。所有治疗组的 IPSS、QoL、SPI 和 BII 均较治疗前有所改善（P<0.05）。只有 TURP 组的 Q(max)长期结果仍有改善（P<0.05）。三组的死亡率相似。TURP、CLP 和 EVAP 的 10 年累积失败率（95%置信区间）分别为 0.11（0.03-0.20）、0.22（0.10-0.35）和 0.23（0.11-0.35）。
平均随访 10.1 年后，TURP、CLP 和 EVAP 治疗后，有 LUTS 症状的 BPH 患者的 IPSS、QoL、SPI 和 BII 均有相似且持久的改善。在整个随访过程中，各组间 Q(max)、PSA 水平和前列腺体积均无统计学差异。然而，只有 TURP 治疗组的 Q(max)有轻微的持久改善。三种治疗方法的成功率和死亡率无统计学差异。
