Netsch Christopher, Stoehrer M, Brüning M, Gabuev A, Bach T, Herrmann T R W, Gross A J
Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany,
World J Urol. 2014 Feb;32(1):165-72. doi: 10.1007/s00345-013-1093-4. Epub 2013 May 9.
To evaluate the safety and efficacy of Thulium VapoEnucleation of the prostate (ThuVEP) for patients on oral anticoagulants (OA) with symptomatic benign prostatic obstruction (BPO).
Fifty-six patients, undergoing ThuVEP at two institutions, were evaluated from May 2009 until June 2011. All patients were at high cardiopulmonary risk and presented with a median American Society of Anesthesiology score of 3 [interquartile range (IQR) 2-3]. Thirty-two patients were on aspirin, 8 were on clopidogrel or clopidogrel and aspirin, and 16 on phenprocoumon at the time of surgery. Patient demographic, perioperative, and follow-up data were analyzed.
Median prostate volume was 50 (IQR 34-76) cc, and resected tissue weight was 32 (IQR 20-50) g. The median operative time was 61.5 (IQR 40-100.75) min, and the catheter time 2 (IQR 2-3) days. There were no perioperative thromboembolic events. Five patients (8.9%) required a second-look operation in the immediate postoperative course (hemorrhage n = 4, residual adenoma n = 1) and four (7.1%) blood transfusions. Complications within the first 30 days included urinary tract infections (1.7%), urinary retention (3.6%), and delayed bleeding (7.1%). These complications were managed conservatively. At 12-month follow-up, median QoL [5 (IQR 3.75-5) vs. 1 (IQR 1-2)], IPSS [21.5 (IQR 15.5-23.75) vs. 5 (IQR 3-8)], Qmax [7.7 (IQR 6.3-10) vs. 28.3 (IQR 21.25-39.2) ml/s], and postvoiding residual urine [100 (IQR 46-200) vs. 17.5 (IQR 0-36) ml] improved significantly (p < 0.002).
Thulium VapoEnucleation of the prostate seems to be a safe and efficacious procedure for the treatment of symptomatic BPO in patients at high cardiopulmonary risk on OA.
评估前列腺铥蒸汽剜除术（ThuVEP）治疗口服抗凝剂（OA）且有症状的良性前列腺梗阻（BPO）患者的安全性和有效性。
对2009年5月至2011年6月期间在两家机构接受ThuVEP手术的56例患者进行评估。所有患者均具有较高的心肺风险，美国麻醉医师协会评分中位数为3[四分位间距（IQR）2 - 3]。32例患者服用阿司匹林，8例服用氯吡格雷或氯吡格雷与阿司匹林联用，16例在手术时服用苯丙香豆素。分析患者的人口统计学、围手术期和随访数据。
前列腺体积中位数为50（IQR 34 - 76）立方厘米，切除组织重量为32（IQR 20 - 50）克。手术时间中位数为61.5（IQR 40 - 100.75）分钟,导尿管留置时间为2（IQR 2 - 3）天。围手术期无血栓栓塞事件发生。5例患者（8.9%）在术后即刻需要二次手术（出血4例，残留腺瘤1例），4例患者（7.1%）需要输血。术后30天内的并发症包括尿路感染（1.7%）、尿潴留（3.6%）和延迟出血（7.1%）。这些并发症均采用保守治疗。在12个月的随访中，生活质量中位数[5（IQR 3.75 - 5）对1（IQR 1 - 2）]、国际前列腺症状评分[21.5（IQR 15.5 - 23.75）对5（IQR 3 - 8）]、最大尿流率[7.7（IQR 6.3 - 10）对28.3（IQR 21.25 - 39.2）毫升/秒]和残余尿量[100（IQR 46 - 200）对17.5（IQR 0 - 36）毫升]均有显著改善（p < 0.002）。
对于口服抗凝剂且有较高心肺风险的有症状BPO患者，前列腺铥蒸汽剜除术似乎是一种安全有效的治疗方法。
