Institute of Urology, Key Laboratory of Urological Diseases in Gansu Province, Gansu Nephro-Urological Clinical Center, The Second Hospital of Lanzhou University, Lanzhou 730000, China.
Asian J Androl. 2012 Sep;14(5):720-5. doi: 10.1038/aja.2012.56. Epub 2012 Aug 20.
This study sought to evaluate the efficacy and safety of photoselective vaporisation (PVP) vs. transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH). Eligible studies were identified from electronic databases (Cochrane Library, PubMed and EMBASE). The database search, quality assessment and data extraction were performed independently by two reviewers. Efficacy (primary outcomes: maximum urinary flow rate (Q(max)), international prostate symptom score (IPSS), postvoid residual urine (PVR) and quality of life (QoL); secondary outcomes: operative time, hospital time and catheter removal time) and safety (complications, such as transfusion and capsular perforation) were explored by using Review Manager 5.0. Six randomized controlled trials (RCTs) and five case-controlled studies of 1398 patients met the inclusion criteria. A meta-analysis of the extractable data showed that there were no differences in IPSS, Q(max), QoL or PVR between PVP and TURP (mean difference (MD): prostate sizes <70 ml, Q(max) at 24 months, MD=0.01, P=0.97; IPSS at 12 months, MD=0.18, P=0.64; QoL at 12 months, MD=-0.00, P=0.96; PVR at 12 months, MD=0.52, P=0.43; prostate sizes >70 ml, Q(max) at 6 months, MD=-3.46, P=0.33; IPSS at 6 months, MD=3.11, P=0.36; PVR at 6 months, MD=25.50, P=0.39). PVP was associated with a shorter hospital time and catheter removal time than TURP, whereas PVP resulted in a longer operative time than TURP. For prostate sizes <70 ml, there were fewer transfusions, capsular perforations, incidences of TUR syndrome and clot retentions following PVP compared with TURP. These results indicate that PVP is as effective and safe as TURP for BPH at the mid-term patient follow-up, in particular for prostate sizes <70 ml. Due to the different energy settings available for green-light laser sources and the higher efficiency and performance of higher-quality lasers, large-sample, long-term RCTs are required to verify whether different energy settings affect outcomes.
本研究旨在评估经尿道前列腺绿激光汽化术（PVP）与经尿道前列腺电切术（TURP）治疗良性前列腺增生（BPH）的疗效和安全性。从电子数据库（Cochrane 图书馆、PubMed 和 EMBASE）中确定合格的研究。数据库搜索、质量评估和数据提取由两名评审员独立进行。使用 Review Manager 5.0 评估疗效（主要结局：最大尿流率（Qmax）、国际前列腺症状评分（IPSS）、残余尿（PVR）和生活质量（QoL）；次要结局：手术时间、住院时间和导管拔出时间）和安全性（并发症，如输血和包膜穿孔）。纳入了 6 项随机对照试验（RCT）和 5 项病例对照研究共 1398 名患者。可提取数据的荟萃分析显示，PVP 和 TURP 之间在 IPSS、Qmax、QoL 或 PVR 方面没有差异（平均差异（MD）：前列腺体积<70ml，24 个月时 Qmax，MD=0.01，P=0.97；12 个月时 IPSS，MD=0.18，P=0.64；12 个月时 QoL，MD=-0.00，P=0.96；12 个月时 PVR，MD=0.52，P=0.43；前列腺体积>70ml，6 个月时 Qmax，MD=-3.46，P=0.33；6 个月时 IPSS，MD=3.11，P=0.36；6 个月时 PVR，MD=25.50，P=0.39）。与 TURP 相比，PVP 术后住院时间和导管拔出时间更短，而手术时间更长。对于前列腺体积<70ml 的患者，与 TURP 相比，PVP 后输血、包膜穿孔、TUR 综合征和血块残留的发生率更低。这些结果表明，在中期随访中，对于 BPH，PVP 与 TURP 同样有效且安全，尤其是前列腺体积<70ml 的患者。由于绿光激光源有不同的能量设置，以及更高质量的激光具有更高的效率和性能，因此需要进行大样本、长期的 RCT 来验证不同的能量设置是否会影响结果。
