Son Hwancheol, Song Sang Hoon, Paick Jae-Seung
Department of Urology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.
Korean J Urol. 2010 Nov;51(11):737-44. doi: 10.4111/kju.2010.51.11.737. Epub 2010 Nov 17.
The latest technical improvements in the surgical armamentarium are remarkable. In particular, advancements in the urologic field are so exceptional that we could observe the flare-up of robot-assisted laparoscopic radical prostatectomy for prostate cancer and laser prostatectomy for benign prostatic hyperplasia (BPH). Photoselective vaporization of the prostate (PVP) and holmium laser prostatectomy are the most generalized options for laser surgery of BPH, and both modalities have shown good postoperative results. In comparison to transurethral prostatectomy (TURP), they showed similar efficacy and a much lower complication rate in randomized prospective clinical trials. Even in cases of large prostates, laser prostatectomy showed comparable efficacy and safety profiles compared to open prostatectomy. From a technical point of view, PVP is considered to be an easier technique for the urologist to master. Furthermore, patients can be safely followed up in an outpatient clinic. Holmium laser enucleation of the prostate (HoLEP) mimics open prostatectomy because the adenomatous tissue is peeled off the surgical capsule in both procedures. Therefore, HoLEP shows notable volume reduction of the prostate similar to open prostatectomy with fewer blood transfusions, shorter hospital stay, and cost reduction regardless of prostate size. Outcomes of laser prostatectomy for BPH are encouraging but sometimes are unbalanced because safety and feasibility studies were reported mainly for PVP, whereas long-term data are mostly available for HoLEP. We need longer-term randomized clinical data to identify the reoperation rate of PVP and to determine which procedure is the ideal alternative to TURP and open prostatectomy for each patient.
外科手术器械库的最新技术改进令人瞩目。特别是，泌尿外科领域的进展非常突出，以至于我们可以看到机器人辅助腹腔镜前列腺癌根治术和良性前列腺增生（BPH）激光前列腺切除术的迅速兴起。前列腺选择性光汽化术（PVP）和钬激光前列腺切除术是BPH激光手术最常用的选择，两种方式都显示出良好的术后效果。与经尿道前列腺切除术（TURP）相比，它们在随机前瞻性临床试验中显示出相似的疗效和更低的并发症发生率。即使在前列腺体积较大的病例中，激光前列腺切除术与开放性前列腺切除术相比，也显示出相当的疗效和安全性。从技术角度来看，PVP被认为是泌尿外科医生更容易掌握的技术。此外，患者可以在门诊进行安全随访。钬激光前列腺剜除术（HoLEP）类似于开放性前列腺切除术，因为在这两种手术中腺瘤组织都从手术包膜上剥离下来。因此，无论前列腺大小如何，HoLEP都显示出与开放性前列腺切除术相似的显著前列腺体积缩小，输血更少，住院时间更短，成本更低。BPH激光前列腺切除术的结果令人鼓舞，但有时并不平衡，因为安全性和可行性研究主要报道的是PVP，而长期数据大多适用于HoLEP。我们需要长期的随机临床数据来确定PVP的再次手术率，并确定对于每个患者来说，哪种手术是TURP和开放性前列腺切除术的理想替代方案。
