Misraï V, Rouprêt M, Guillotreau J, Bordier B, Bruyère F
Clinique Pasteur, 40, avenue de Lombez, 31300 Toulouse, France.
Prog Urol. 2013 Feb;23(2):77-87. doi: 10.1016/j.purol.2012.10.013. Epub 2012 Nov 26.
Transurethral resection of the prostate (TURP) is the most common surgical procedure in urology and remains the gold standard treatment of complicated benign prostatic hyperplasia or refractory to medical treatment. Routinely used since the 2000s, prostate photoselective vaporization (PVP) with Greenlight(®) laser has been developed to improve the safety of hemostasis in elderly patients and/or with high surgical risk. The purpose of this study was to review the results of PVP from the international literature.
[corrected] A systematic review of the literature on the research base Pubmed (http://www.ncbi.nlm.nih.gov/) was performed using the keywords benign prostatic hyperplasia; greenlight; photovaporisation; Laser; IPSS score; endoscopicsurgery; morbidity; complication. Prospective and retrospective studies in English and French were selected from its first use in 1998. Finally, we looked for studies that reported at least one of the following items: surgical technique; operative data; complications; anatomical and functional results and/or direct comparison between PVP and TURP.
Regardless the PVP technique used to treat adenoma and identify the limits of the prostatic capsule, some parameters are well defined (sweepspeed, angle and distance of the fiber with the tissue) but others are still debated (number of joules per volume, when do we have to stop the PVP) and are reported in a heterogeneous manner due to the different generators. Versus TURP, PVP would offer the same functional results in the medium term but with a lower risk of per- and postoperative bleeding. The study of the risk of erectile dysfunction (ED) after PVP is made difficult due to the heterogeneity of DE assessment and study populations. However, PVP does not seem associated with an increased risk of ED versus TURP. The lack of histological material should lead to preoperative individual screening of prostate. The economy generated by PVP regarding the decrease in average length of stay has been clearly identified in Australia, Canada, Switzerland and USA. Studies will be published soon on French economic model.
PVP with Greenlight(®) laser appears to be a safe and effective technique. With the new generator XPS, the PVP technique reaches maturity. Its development will certainly lead to a long-term evaluation with high levels of evidence based.
经尿道前列腺切除术（TURP）是泌尿外科最常见的手术，仍是复杂良性前列腺增生或药物治疗无效病例的金标准治疗方法。自21世纪以来常规使用的绿光（®）激光前列腺光选择性汽化术（PVP），旨在提高老年患者和/或手术风险高的患者止血的安全性。本研究的目的是回顾国际文献中PVP的结果。
[已校正] 使用关键词“良性前列腺增生；绿光；光汽化；激光；国际前列腺症状评分（IPSS）；内镜手术；发病率；并发症”，对研究数据库PubMed（http://www.ncbi.nlm.nih.gov/）上的文献进行系统回顾。从1998年首次使用起，选取英文和法文的前瞻性和回顾性研究。最后，我们寻找报告了以下至少一项内容的研究：手术技术；手术数据；并发症；解剖和功能结果和/或PVP与TURP之间的直接比较。
无论使用何种PVP技术治疗腺瘤并确定前列腺包膜界限，一些参数已明确界定（扫描速度、光纤与组织的角度和距离），但其他参数仍存在争议（每体积的焦耳数、何时停止PVP），并且由于发生器不同，报告方式各异。与TURP相比，PVP在中期可提供相同的功能结果，但围手术期和术后出血风险较低。由于勃起功能障碍（ED）评估和研究人群的异质性，PVP术后ED风险的研究存在困难。然而，与TURP相比，PVP似乎不会增加ED风险。缺乏组织学材料应导致术前对前列腺进行个体化筛查。在澳大利亚、加拿大、瑞士和美国，已明确PVP在缩短平均住院时间方面产生的经济效益。关于法国经济模型的研究将很快发表。
绿光（®）激光PVP似乎是一种安全有效的技术。随着新型XPS发生器的出现，PVP技术已臻成熟。其发展必将带来基于高证据水平的长期评估。
